Sen. Reny introduces bill to help Maine patients access specialty care

Posted: March 08, 2023 | Health Coverage, Insurance and Financial Services, Senator Reny

AUGUSTA – On Tuesday, Sen. Cameron Reny, D-Bristol, introduced a bill that would help Maine patients access specialty health care in a timely, efficient manner. LD 722, “An Act to Expedite the Health Insurance Referral Process for Specialists by Allowing Referrals from Urgent Care Facilities,” was the subject of a public hearing before the Legislature’s Committee on Health Coverage, Insurance and Financial Services.

Senator Cameron Reny

“In my work as a school counselor, I’ve seen far too many heartbreaking cases of young people who have a mental health crisis requiring treatment in an emergency room or urgent care facility, only to be told by their insurance provider that they’d need a referral from a primary care physician in order to receive coverage for ongoing mental health care,” said Sen. Reny. “Wait times to get in to see a primary care physician and specialist are increasing. We need to be doing all we can to make sure Mainers can get the care they need, when they need it.”

LD 722 would prohibit a health insurance provider from denying payment for any health care service covered under an enrollee’s health plan provided by a specialist based solely on the basis that the enrollee’s referral was not made by the enrollee’s primary care provider as long as the referral is made by a provider employed at an urgent care facility. 

A national survey conducted in 2022 by AMN HealthCare and Merritt Hawkins shows that wait times to see a primary care physician have increased by 8% since 2017 and by 24% since 2004. This translates to an average wait time of 26 days to schedule a new patient physician appointment. The survey also highlights that the wait times for certain specialties, such as orthopedic surgery, also have increased significantly.

In Maine, Data from the American Medical Association shows that the number of providers per 10,000 children aged 0-17 years is concerning. While Cumberland County has 15.6 pediatricians per 10,000 children, other counties have shockingly low numbers, such as Somerset County, with only 1 pediatrician for every 10,000 children. According to Northern Light Acadia Hospital and the CEO of Kennebec Behavioral Health, waitlists for mental health specialists are months long, with many patients waiting 15 to 30 weeks to get an appointment.

The Maine Bureau of Insurance testified in favor of LD 722.

The bill faces further action in committee.