But to uncover violations, commissioners will rely heavily on complaints from patients and doctors, according to the National Association of Insurance Commissioners. And Howrigon notes that doctors and patients won't know to complain unless they are aware of their rights under the new laws.

Howrigon also emphasized that state-issued fines and penalties might not be enough to cow insurance giants that make tens of billions of dollars in profits. And, he noted, in 11 states insurance commissioners are elected and often get campaign donations from the companies they regulate.

A better enforcement approach, he suggested, would be to hold the medical directors within insurance companies accountable for decisions that harm patients.

"If those doctors had the same accountability and responsibility as the doctors who are writing the prescriptions, meaning they could be sued for malpractice ... all of this would go away," Howrigon said.

Under a prior authorization bill advancing in Oklahoma, insurance company medical directors could be held liable for medical malpractice, opening them up to lawsuits.

"I have had doctors tell me this is what is some of the best legislation they've seen in the country. It's fair to the insurance company and it's fair to the to the patient," said Republican state Rep. Ross Ford, one of the cosponsors. "It gives the right balance of oversight, but it also goes far enough to hold the insurance company responsible if they choose to deny a procedure."

Three months of limbo

In Arizona, a bill has been introduced that would require insurers to honor prior authorizations for at least 90 days, even if the patient switches insurers. But according to the Arizona Department of Insurance, it would not apply to Medicaid.

That means it wouldn't apply to Amina Tollin.

Medicaid finally approved Tollin for her infusions in late March. But through the three months of limbo, she says her symptoms — including pain, exhaustion, numbness and tingling — were agonizing.

She fears that at some point in the future, Arizona Medicaid might once again refuse to cover the infusions, which are covered for the next twelve months.

"I feel like I won, but I didn't really win because it's going to be a whole new fight in a year," she said.

©2024 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.