More Information / History
SEE UPDATE ON MAIN PAGE- ACTION NEEDED: Please contact Senator Katherine Klausmeier (sponsor) immediately and tell her NO to both SBO215 and SBO217. These bills were designed solely to benefit insurers. The bills reduce insurance coverage for Marylanders who may be injured on the job.
Senator Klausmeier is not only the sponsor of these bills, she is the Senate Chair for the Worker's Compensation Insurance Oversight Committee.
Senator Klausmeier's Contact Information
UPDATE- January 24, 2014: The Senator introduced the bill. Rather than the original "72 hours" doctors would have to prescribe and dispense medications after an injury, they extended it to 30 days. The limit of only 30 days of medications to be covered remains intact.
ABOUT THE BILLS: These bills will not only negatively affect those bitten by ticks while on the job, they will affect anyone who has a job (indoors or out), or anyone who will some day have a job in any profession. If passed, this insurance-friendly concept could spread like wildfire to legislators who are under the thumb of insurers in other states, and be adopted by non-worker's compensation insurers nationwide.
The bills remove workers compensation insurance coverage (which is already in place) that covers doctor prescribed medications. This would force you, if injured in any way, to pay for your medications, or drown while trying to navigate the "insurance system". Paying for medications is an expense no one should suddenly be saddled with, especially while hurting and off work recovering from an injury.
SBO215 limits the duration of treatment coverage to 90 days, without regard for the condition of the patient. The bills protect insurers from having to pay for your medications if not prescribed within 72 hours of your injury. If you contract a tick borne disease and your medications are not prescribed within 72 hours, you're out of luck.
[Tip- don't get bitten by ticks or injured otherwise on the weekend, a holiday or when your doctor has a back-log of patients and can't see you immediately.]
The bills permit insurers to dictate conditions surrounding treatment coverage even when a licensed doctor prescribes your medications. Are insurance clerks qualified to make medically-related decisions affecting your health and your treatment options?
SBO217 goes even further to deteriorate your rights. First of all, it requires physicians and patients to jump through numerous hoops in order for prescribed medications to be covered, such as requiring physicians and patients to enter into and provide a substance abuse management plan if prescribed pain medications.
The bill adds additional burdens to physicians prescribing pain medications (paperwork) and opens them up to more scrutiny. It allows employers and insurers to use an assessment of your psychiatric health or conditions (with no testing or confirmation required), and/or past substance use and abuse to determine current coverage for medications prescribed for your job-related injury.
Insurers can deny treatment coverage if you are prescribed one or more of 80 plus pain medications and do not submit to a urine drug test every 30 days.
Your doctor must also have permission from your EMPLOYER or its insurer before prescribing medications in order for the medications to be covered.
Your doctor must review with you the importance of therapy or other activities to reduce your pain before a pain medication can be covered. [The infamous Johns Hopkins Lyme disease treatment plan- "you don't need medicine, you just need to exercise more and take anti-depressants".]
For certain medications to be covered, your doctor, using only "validated instruments", must assess your physical functioning and pain intensity at each visit. The insurer will then use this information to determine if your medications should be covered. Of course, doctors will not be paid for the additional time it takes to perform these assessments. They can just absorb the costs. Will the new policies deter even more doctors from accepting worker's compensation insurance?
If treatment for chronic pain is prescribed for more than 90 days, your doctor must complete a report that contains your detailed personal history- specifying such things as your previous drug, alcohol, or tobacco use, and disclosing your phychiatric history, including weather he/she thinks you have any affective disorders or personality disorders. [Tip: Don't act like you know anything about Lyme disease, or request treatment beyond 10 days, or you may be diagnosed with having a mental condition.]
This personal information they gather can then be used to deny coverage. See information about IDIOPATHIC (pre-existing) conditions and how they, when disclosed, are used to deny benefits by clicking here.
QUESTION: Does this bill interfere with federal laws designed to protect you? Maryland's leading workers compensation provider tells employers, in an effort to save themselves money:
"Important: While federal law does not permit you to ask employees about their medical history, if you happen to have knowledge that one of your injured workers has an idiopathic condition, it is imperative that you notify your assigned claims adjuster as soon as possible. The adjuster can then perform the appropriate claims investigation and obtain all of the necessary medical documentation in an effort to properly defend the claim."
Source:
Bill # SBO215
Synopsis- Prohibiting employers or their insurers, except under specified circumstances, from being required to pay for prescriptions that are dispensed by physicians to covered employees who have suffered accidental personal injuries, compensable hernias, or occupational diseases. See bill here:
http://mgaleg.maryland.gov/2014RS/bills/sb/sb0215F.pdf
Bill # SBO217
Synopsis- Prohibiting employers or their insurers from being required to pay under workers' compensation law for a controlled dangerous substance that is prescribed by a physician for covered employees who have suffered accidental personal injuries, compensable hernias, or occupational diseases; etc. See bill here:
http://mgaleg.maryland.gov/2014RS/bills/sb/sb0217F.pdf
Who benefits from the passage of these bills?
These bills cater to the financial interests of the insurers, period. They are not in the best interest of Maryland workers who may be injured on the job, or the doctors who treat them.
Insurers should not be permitted to dictate what treatments should or should not be covered for any injury or occupational disease. YOU and your doctor are the ones who together should decide what treatments are necessary and the treatment should then be covered. That is your right and it should not be compromised by these bills.
(SEE UPDATE ABOVE) WHAT CAN I DO?
Please contact Senator Katherine Klausmeier immediately and tell her to withdraw the bills (SBO215 and SBO217). She is the sponsor of both of these bills that were designed solely to benefit insurers, while at the same time she is the Senate Chair for the Worker's Compensation Insurance Oversight Committee.
Senator Klausmeier's Contact Information
WATCH FOR THE HOUSE BILLS
House Bills (companion bills) to Senator Klausmeier's bills have not been introduced yet; however, Delegate Jameson introduced a House version (HB 174) of the current Senate bill, SBO215, last year and may attempt to do the same again this year. http://mgaleg.maryland.gov/2013RS/bills/hb/hb0174f.pdf
You can watch for the introduction of House bills using this link, click here.
In the meantime, please contact Delegate Jameson's office and tell her NOT to introduce the bill(s). These bills should be nipped in the bud before they become a real problem for you, your friends and family members, as well as future generations.
Delegate Sally Jameson Contact Information
Quote from Fiscal & Policy Notes (the official reasoning behind the bills):
"Injured Workers’ Insurance Fund (IWIF) Effect: Potential decrease in IWIF [insurer] expenditures due to any savings realized for prescriptions covered under workers’ compensation insurance."
Fiscal and Policy Note- the background information about House & Senate bills, from 2013: http://mgaleg.maryland.gov/2013RS/fnotes/bil_0004/hb0174.pdf
Both Senate bills are currently in the Senate Finance Committee. Please feel free to contact the Finance Committee members and share your concerns, even if your message is simply a quick- "Say No to SBO215 and SBO217." Here is their contact info.
http://mgaleg.maryland.gov/webmga/frmMain.aspx?pid=cmtepage&stab=04&id=fin&tab=subject3&ys=2014RS
Points To Ponder
When employees are required to pay for their own medications, will Worker's Compensation insurance premiums for Maryland employers be reduced to reflect the changes? Or do insurers expect to enjoy an increase in annual profits as a result of these self-serving bills?
Passage of the bills will interfere with people obtaining immediate access to and insurance coverage for pain medications (severe or acute injuries), heart meds (firefighters/police/etc), etc. and medications such as antibiotics that may need to be taken immediately and/or uninterrupted for several months.
The growing number of Maryland workers contracting Lyme and tick borne diseases may find themselves responsible for paying for medications they thought were covered, and not even know about this policy until weeks to months after the fact.
Isn't it time to say ENOUGH?
Medically Dangerous- As you may know, if Rocky Mountain Spotted Fever is even suspected it is to be treated immediately. All experts agree, the sooner someone is treated for Lyme or any of the tick borne diseases found in Maryland, the better. If your doctor can provide medications on the spot to prevent further deterioration, complications and even death, isn't that preferable to waiting for your insurer to get around to approving your medications?
Ask Yourself- do you have an extra $1,000 per month available to pay for treating Babesiosis, a potentially deadly tick borne disease anyone can contract while working outdoors in Maryland? Can you afford one or more doctor prescribed medications to reduce your pain after requiring emergency surgery on an ankle you broke while on the job? If a firefighter is severely burned, or a police officer is shot or injured in a vehicle accident while on duty, should they be forced to pay for their medications?
More Red Tape To Wade Through, Both Before and After Treatment- To create an additional burden for doctors and patients by forcing them to complete additional paper work required by the bills is not the direction that should be taken to improve patient care. To expect someone who is injured and potentially traumatized to navigate though the workers compensation insurance system, file the required paper work, honor their employer's and sub-contractors rules and regulations, etc. only serves to delay or deny necessary treatment coverage for initial prescriptions and refills.
Final Thought: Maryland law requires employers to have insurance coverage to protect employees injured on the job. If you remove access to or limit necessary, potentially life-saving medication coverage, why force employers to pay premiums and carry Worker's Compensation coverage?