LD 1155- An Act To Protect Patients and the Prudent Layperson Standard

AUGUSTA –  Speaker of the House Sara Gideon (D-Freeport) introduced LD 1155, “An Act To Protect Patients and the Prudent Layperson Standard.” In several states, insurance companies have been warning policy holders that if their emergency department visit results in a diagnosis for something that the insurer doesn’t think was an emergency, the insurer will deny payment of the claim leaving the patient responsible for the bill. This legislation will prevent insurance companies from denying emergency room claims by requiring companies to cover visits based on the patient’s presenting symptoms, not the final diagnosis. It also prohibits a carrier from requiring prior medical authorization for emergency services.

Speaker Gideon released the following statement:

“If Mainers think they are having a medical emergency, they should be seeking emergency care, not self-diagnosing and worrying if their insurance company is going to pay the bill. Unfortunately, there is a long history of companies denying coverage and using scare tactics to prevent people from seeking the care they need. This type of dangerous insurer policy can leave patients on the hook for thousands of dollars of medical bills and violates federal policy. This legislation will ensure that this type of dangerous practice is banned and those suffering a medical emergency can focus on what’s most important – their health and wellbeing.”

A public hearing on LD 1155 will be held in the Health Coverage, Insurance and Financial Services Committee in the coming weeks.