NAII Says Colo. No-Fault Regulation Would Not Allow Pre-Authorization Requirement for Medical Care

August 16, 2002

A proposed Colorado regulation would prohibit auto insurers from requiring pre-authorization before someone injured in an auto accident receives medical treatment under the state’s no-fault insurance law, according to the National Association of Independent Insurers (NAII). The Insurance Division regulation also would hold auto insurers responsible for delays in treatment by managed-care organizations.

NAII local lobbyist Bill Imig asked the division to amend both those provisions.

“The essence of managed care is pre-authorization,” Imig said in a letter to Deputy Insurance Commissioner Maryellen Waggoner. He suggested the language in question be changed to: “A medical review decision cannot be based solely on whether or not the treatment was pre-authorized. The medical treatment must be evaluated for medical necessity using the same process and criteria as are used in a normal review, and must be based on the information available before the procedure was completed.”

Imig further suggested that a provision holding auto insurers responsible for delays in treatment by managed care organizations either be deleted or changed to state that an insurer’s contract with a managed care organization must contain language requiring timely payments in accordance with national accreditation standards. The provision would say that medical review decisions must be completed within 48 hours or two business days after the request is received.

In addition, Imig said NAII agreed with former Insurance Commissioner William Kirven’s position that the new regulation should not become effective until Jan. 1, 2003. Just before the regulation was originally to go into effect, on July 1, 2002, Kirven issued an emergency regulation extending its effective date to Sept. 30. He subsequently stated the effective date should be put off until next Jan. 1. Kirven’s last day in office was Aug. 9.

Imig said an effective date of Jan. 1, 2003, would be appropriate since insurers would need time to develop disclosure forms required by the new regulation and that date also would be consistent with the new law.

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