Every December brings new opportunities to make lists: gifts, holiday cards, New Year’s resolutions.
But for physicians like me, there’s also an ever-present policy wish list full of ways to improve patient care and break through the red tape that limits our ability to help more Oklahomans.
As we approach a new year and a new Congress, it is essential to explore how lawmakers will have the power to improve health care in 2025 and beyond.
In speaking with patients and colleagues, insurance-related issues were one of their top concerns, so I would be remiss if I didn’t include some of those on my 2025 wish list.
First, Oklahoma must limit the use of artificial intelligence and automated systems to review patient procedures and treatments. Imagine this. Treatment for you or a loved one will be denied or delayed simply because a computer model says it’s not medically necessary. This is infuriating and we must advocate for bringing humanity back to the claims process by ensuring that all insurance pre-authorizations are verified by a qualified physician rather than a computer.
Another insurance-related concern was payment “clawback” practices. Under current Oklahoma law, insurance companies have up to 18 months after approving a medical procedure or treatment to change their mind or “take back” payment to the provider. This practice is not only confusing but also expensive, and ultimately leaves patients with medical bills they thought were covered. Reversing this practice can provide patients with much-needed peace of mind.
The new Medicaid managed care reimbursement system, currently run by private sector cost-cutting insurance companies, is unwieldy and extremely slow. Patients are left in limbo while doctors wait for payment, and some are forced to take out loans as a stopgap measure so that they don’t have to continue operating and delaying patient care. Once much-needed improvements to this process are approved, healthcare providers will be able to focus on what they do best: caring for patients.
Drug formulary and prior authorization requirements are notoriously inconsistent among Medicaid managed care companies, creating headaches for physicians when writing prescriptions. By cracking down on this, legislators can eliminate confusion, reduce administrative burden, and ensure that patients receive quality care no matter which provider they choose.
I sincerely hope that all Oklahomans receive the care they deserve without having to jump through endless hoops. By advocating for these changes, we hope to chart a path toward a health care system that aligns with what’s right for patients and the physicians who serve them.
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