As a doctor, when I am deciding the best course of treatment, it is not just a patient’s symptoms that I consider. Lab results, medication interaction risks and medical history are all factors that go into ensuring the right level of care.

But rather than recognizing the value of personalized treatment, insurers will attempt to lower payments to doctors through a process known as “downcoding.” Without ever seeing the patient or understanding why they need the treatment prescribed, an automated system alters the charges. Instead of using the codes that reflect the complex or high-level care provided, insurers too often substitute lower-cost codes.

This helps their bottom line, but it is wildly inaccurate, undermines clinical judgment and creates serious burdens for our practices.

Doctors can appeal and argue against these automated downcoding changes, but doing so often means hours of paperwork and waiting on hold to get the payment they deserve. Insurers should not be second-guessing physicians, who are consistently rated one of the most trusted professions in the country!

That is why I am grateful to Gov. JB Pritzker and Illinois lawmakers for passing the Transparency in Downcoding Act. The new law does not prevent insurers from using technology to identify claims for review. But it does ensure that decisions to reduce reimbursement are based on human evaluation and established coding standards, rather than automation alone.

Illinois has taken an important step toward ensuring that technology supports patient care instead of creating new barriers to it. I thank our state leaders for recognizing that physicians — not algorithms — should have the final say when it comes to evaluating the complexity of the care we provide.

Dr. Amanda Myers

Chicago