West Virginia
The Journal
Martinsburg, West Virginia
Lyme disease treatment best decided by doctor, patient
MAR 25, 2018
Gov. Jim Justice signed legislation this week preventing insurance companies from denying coverage for Lyme disease treatments.
This is good news for residents here in the Eastern Panhandle, which has the highest number of tick bite reports in West Virginia.
The legislation was promoted by a Berkeley Springs couple, Eric and Linda Pritchard. Since at least the summer, the couple has been conducting a public information campaign. If it weren’t for the couple’s diligence, this law may not have been passed.
We’re grateful for their hard work, and for the efforts of Eastern Panhandle lawmakers, who recognized insurance companies denial of such coverage was unacceptable.
The West Virginia legislation was endorsed by state Sen. Charles Trump, R-Morgan, chairman of the state Senate Judiciary Committee. Senate Bill 242 was also co-sponsored by Sens. Craig Blair, R-Berkeley, and Patricia Rucker, R-Jefferson. A comparable House Bill 4328 was co-sponsored by Del. Jill Upson, R-Jefferson.
Lyme disease is caused by a bacteria infection that is primarily transmitted to humans through bites from deer ticks.
The new law requires insurance companies to pay costs for Lyme disease treatments, including detection tests and antibiotics prescribed by a doctor.
The disease is painful for those suffering from it.
Symptoms of Lyme disease can vary depending on the stage of the disease, according to the Centers for Disease Control and Prevention.
Early symptoms may include fever, chills, headache, fatigue, muscle and joint aches, swollen lymph nodes and rash.
Without proper treatment, these symptoms grow worse. Days to months after a tick bite, the symptoms may progress to severe headaches and neck stiffness, arthritis with severe joint pain and swelling, facial palsy, pain in tendons, muscles, joints and bones, heart palpitations, inflammation of the brain and spinal cord, nerve pain and problems with short-term memory, the CDC reports.
Clearly, Lyme disease can turn into something serious if not treated.
According to Eric Pritchard, insurance companies, however, have adopted policies that rely on medical authorities, such as the Infectious Diseases Society of America, which have questioned whether long-term antibiotic treatment is effective for conditions associated with chronic Lyme disease.
Those suffering from chronic Lyme disease, however, often have low quality of life. Treatment – which is best decided by a patient and his/her doctor and not insurance companies — increases the possibility something can be done to help these patients.
But treatments are often expensive.
Requiring insurance companies to cover such treatments is the humane thing to do. We’re happy to see lawmakers in the state recognize this.
Link To Article
Text
Bill Title: Requiring health insurance providers provide coverage for certain Lyme disease treatment
Spectrum: Partisan Bill (Republican 4-0)
Status: (Passed) 2018-03-10 - Approved by Governor 3/20/18 - Senate Journal [SB242 Detail]
Download: West_Virginia-2018-SB242-Enrolled.html
WEST virginia Legislature
2018 regular session
Enrolled
Senate Bill 242
By Senators Trump, Blair, Maroney, and Rucker
[Passed March 8, 2018; in effect 90 days from passage]
AN ACT to amend the Code of West Virginia, 1931, as amended, by adding thereto a new section, designated §33-6-38; to amend said code by adding thereto a new section, designated §33-15-4p; to amend said code by adding thereto a new section, designated §33-16-3zz; and to amend said code by adding thereto a new section, designated §33-25A-8p, all relating to requiring health insurance providers to provide coverage for long-term antibiotic therapy for a patient with Lyme disease.
Be it enacted by the Legislature of West Virginia:
ARTICLE 6. THE INSURANCE POLICY.
§33-6-38. Lyme disease to be covered by all health insurance policies.
All individual and group health insurance policies providing coverage on an expense-incurred basis and individual and group service or indemnity type contracts issued by a nonprofit corporation shall provide coverage for long-term antibiotic therapy for a patient with Lyme disease when determined to be medically necessary and ordered by a licensed physician after making a thorough evaluation of the patient’s symptoms, diagnostic test results, or response to treatment.
ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.
§33-15-4p. Lyme disease to be covered by all health insurance policies.
Any insurer who, on or after January 1, 2019, delivers or issues a policy of accident and sickness insurance in this state under the provisions of this article shall make available as benefits to all subscribers and members coverage on an expense-incurred basis and individual and group service or indemnity type contracts issued by a nonprofit corporation shall provide coverage for long-term antibiotic therapy for a patient with Lyme disease when determined to be medically necessary and ordered by a licensed physician after making a thorough evaluation of the patient’s symptoms, diagnostic test results, or response to treatment.
ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.
§33-16-3zz. Lyme disease to be covered by all health insurance policies.
Any insurer who, on or after January 1, 2019, delivers or issues a policy of group accident and sickness insurance in this state under the provisions of this article shall make available as benefits to all subscribers and members coverage on an expense-incurred basis and individual and group service or indemnity type contracts issued by a nonprofit corporation shall provide coverage for long-term antibiotic therapy for a patient with Lyme disease when determined to be medically necessary and ordered by a licensed physician after making a thorough evaluation of the patient’s symptoms, diagnostic test results, or response to treatment.
ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.
§33-25A-8p. Lyme disease to be covered by all health insurance policies.
A health maintenance organization issuing coverage in this state pursuant to the provisions of this article shall make available as benefits to all subscribers and members coverage on an expense-incurred basis and individual and group service or indemnity type contracts issued by a nonprofit corporation shall provide coverage for long-term antibiotic therapy for a patient with Lyme disease when determined to be medically necessary and ordered by a licensed physician after making a thorough evaluation of the patient’s symptoms, diagnostic test results, or response to treatment.
SB 242
https://legiscan.com/WV/bill/SB242/2018
Votes- Roll Call
https://legiscan.com/WV/rollcall/SB242/id/719365
Roll Calls
2018-03-08 - House - Passed House (Roll No. 398) (Y: 93 N: 5 NV: 1 Abs: 0) [PASS]
2018-01-31 - Senate - Passed Senate with amended title (Roll No. 38) (Y: 29 N: 1 NV: 0 Abs: 4) [PASS]
History
Date Chamber Action 2018-03-10
Senate Approved by Governor 3/20/18 - Senate Journal
2018-03-20 Senate Approved by Governor 3/20/18
2018-03-10 House Approved by Governor 3/20/18 - House Journal
2018-03-10 Senate To Governor 3/19/18 - Senate Journal
2018-03-19 Senate To Governor 3/19/18
2018-03-10 House To Governor 3/19/18 - House Journal
2018-03-09 Senate House Message received
2018-03-08 House Completed legislative action
2018-03-08 House Communicated to Senate
2018-03-08 House Passed House (Roll No. 398)
2018-03-08 House Read 3rd time
2018-03-08 House On 3rd reading, Special Calendar
2018-03-07 House Read 2nd time
2018-03-07 House On 2nd reading, Special Calendar
2018-03-06 House Read 1st time
2018-03-06 House On 1st reading, Special Calendar
2018-03-05 House Do pass
2018-03-02 House To House Judiciary
2018-03-02 House Do pass, but first to Judiciary
2018-02-01 House To House Health and Human Resources
2018-02-01 House To Health and Human Resources then Judiciary
2018-02-01 House Introduced in House
2018-01-31 Senate Ordered to House
2018-01-31 Senate Passed Senate with amended title (Roll No. 38)
2018-01-31 Senate Read 3rd time
2018-01-31 Senate On 3rd reading
2018-01-30 Senate Maroney Floor amendments adopted (Voice vote)
2018-01-30 Senate Takubo Floor amendments adopted (Voice vote)
2018-01-30 Senate Read 2nd time
2018-01-30 Senate On 2nd reading
2018-01-29 Senate Read 1st time
2018-01-29 Senate On 1st reading
2018-01-26 Senate Reported do pass
2018-01-11 Senate To Health and Human Resources
2018-01-12 Senate Introduced in Senate
2018-01-11 Senate To Health and Human Resources
2018-01-11 Senate Filed for introduction
Same As/Similar To
HB4328 (Similar To) 2018-01-26 - To House Banking and Insurance
SB242 (Carry Over) 2017-02-23 - To House Education
Subjects
Code Citations
ChapterArticleSectionCitation TypeStatute Text33 15 4l New Code See Bill Text
33 15 4p New Code See Bill Text
33 16 3x New Code See Bill Text
33 16 3zz New Code See Bill Text
33 25A 8l New Code See Bill Text
33 25A 8p New Code See Bill Text
33 6 38 New Code See Bill Text
West Virginia State Sources
TypeSource
TypeSourceSummary http://www.wvlegislature.gov/Bill_Status/Bills_history.cfm?input=242&year=2018&sessiontype=RS&btype=bill
Roll Call http://www.legis.state.wv.us/legisdocs/2018/RS/votes/senate/01-31-0038.pdf
Roll Call http://www.legis.state.wv.us/legisdocs/2018/RS/votes/house/00398.pdf