Politics & Government

Regulator: Insurers must help pay for urine tests required by Ky. drug law

Gov. Steve Beshear. Photo by John Flavell
Gov. Steve Beshear. Photo by John Flavell John Flavell

State regulators said this week they're working with private insurance companies and Medicaid managers to make sure health insurance plans help cover the cost of urine tests required under House Bill 1, the so-called "pill mill bill."

Also, Gov. Steve Beshear credited HB 1 on Tuesday with reducing the number of prescriptions for frequently abused controlled substances and closing the doors of 10 pain-management clinics.

"We knew that this bill would have an immediate impact on thwarting the abuse and diversion of prescription drugs in our state, and the statistics over the last few months are already showing progress," Beshear said in a statement.

Responding to public complaints, the Kentucky Department of Insurance is communicating with insurers to guarantee that urine tests under HB 1 are classified as a medically necessary expense, Insurance Commissioner Sharon Clark said. The Kentucky Cabinet for Health and Family Services is doing the same for Medicaid clients.

"From our discussions with company representatives, it does not appear that this was ever a widespread problem, and insurers indicate these tests are a covered benefit," the Insurance Department said in a prepared statement.

To curb prescription drug abuse, this summer, Kentucky started requiring people with long-term prescriptions for controlled substances to submit to urine testing. The tests determine whether patients take their medicine, rather than sell it, and whether other, unprescribed drugs are in their systems.

Last month, the Lexington Herald-Leader reported on scattered complaints of patients who were charged hundreds of dollars for urine tests and whose insurance companies denied coverage because the tests were not considered medically necessary. One retired couple in Lexington was billed $932 for two urine tests that were required for prescription refills. The couple's insurer, Bluegrass Family Health, refused to pay for the tests.

The Insurance Department investigated that case and corrected it, Clark said. The lab tests had been improperly coded during the billing process, she said.

Cynthia Burton, the retired nurse who faced $932 in bills with her husband, confirmed Monday that Bluegrass Family Health said it's now willing to pay all but $91. Burton had protested her insurer's initial denial to Gov. Steve Beshear and state Rep. Stan Lee, R-Lexington, among others.

"This is much better, and I appreciate it," Burton said. "But it continues to be a problem out there for a lot of people. Look at all the calls and the noise I had to make just to get this fixed. How many people are in a position to do that? A lot of folks are just going to get stuck with these bills, and they won't be able to pay them and their credit will be ruined."

Clark said other Kentuckians who have complaints about insurance coverage of urine tests required under HB 1 may call the Insurance Department toll-free at 1-800-595-6053.

State officials said they don't know how many Kentuckians will be required to submit to urine testing under HB 1. They also don't know how much the tests are supposed to cost, although they're researching that information.

Doctors can order patients to submit to targeted drug screening, which should be cheaper, or comprehensive drug screening, which is likely to cost more, they said. Tests should begin at $65, said Lloyd Vest, general counsel for the Kentucky Board of Medical Licensure, which helped write the regulations for HB 1. Vest said he has heard of isolated instances in which tests cost $500 to $600.

"Our assumption — and maybe it was a faulty assumption — was that doctors were familiar with the testing process, so they knew which tests to order," Vest said. "Our understanding was, the doctor could pick the test that made the most sense for each individual patient. So this response has been a little surprising to us."

Lawmakers passed HB 1 in April to address hundreds of deaths reported annually in Kentucky from prescription drug overdoses, and a scourge of crime by pill addicts desperate to feed their craving.

Apart from the urine tests, there is debate over how the law affects doctors — requiring them to complete patients' medical histories, check photo identifications, conduct physical exams and consult a statewide prescription database before they issue prescriptions for controlled substances.

The Beshear administration and the General Assembly are expected to make changes to HB 1 and its regulations this winter, after the legislature convenes in January. A legislative panel is scheduled to hear more updates and concerns about the law on Wednesday in Frankfort.

In a prepared statement Tuesday, Beshear's office credited HB 1 with the closing earlier this year of 10 of 44 pain-management clinics known to operate in Kentucky. The law also has greatly expanded use of the prescription monitoring database known as KASPER.

The number of health care providers registered to use KASPER has jumped from 7,911 when lawmakers approved HB 1 in April to 21,542 as of Oct. 1. The average number of daily reports produced by KASPER has increased from 2,888 a year ago to 18,149 today, according to Beshear's office.

At the same time, the prescription monitoring system has recorded a 6 percent to 9 percent drop in prescriptions for frequently abused drugs including hydrocodone, oxycodone and alprazolam, or Xanax, according to the statement.

"What we are beginning to see is the impact of medical providers reviewing KASPER reports and making changes in patient treatment. This not only puts the brakes on doctor shoppers, it also improves patient care," said Van Ingram, executive director of the Kentucky Office of Drug Control Policy.