LD 1155, “An Act To Protect Patients and the Prudent Layperson Standard” , was voted out of committee with unanimous support

AUGUSTA – LD 1155, “An Act To Protect Patients and the Prudent Layperson Standard,” received unanimous support of the Legislature’s Committee on Health Coverage, Insurance and Financial Services (HCIFS) on April 2, 2018. Speaker Gideon introduced the bill early last month and testified in support of the before the HCIFS Committee on March 26, 2019.

“We must proactively protect Maine consumers, making sure that they are able to seek emergency medical care at the critical moment when they need it,” said Speaker Gideon.  “No person should be put in the position of trying to self diagnose or second guess when a medical emergency strikes.  This bill makes sure that all people have access to healthcare when they need it. .”

LD 1155 strengthens existing law preventing  insurance companies from denying emergency room claims by requiring these companies to cover visits based on the patient’s presenting symptoms, not the final diagnosis. It also strengthens existing law prohibiting a carrier from requiring prior medical authorization for emergency services. 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  or reduce the payment of the claim. This leaves the patient responsible for the bill.

The committee will be amending LD 1155 to ensure that emergency transport vehicles are covered under this provision, as well.

The bill awaits additional votes in the Maine House and Senate.