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Study: Insurance Companies Are Rejecting Doctor’s Orders To Save Money

Young brazilian doctor checking patient information on a tablet device

A recently released study confirms what many sick Americans already are experiencing: health insurance companies are rejecting doctor’s orders to save money and are potentially harming patient health in the process.

Wait, this is a thing?

Somehow, insurance companies are getting away with having these outrageous policies, and people often are unaware of these common practices until they face a devastating denial that prevents them from getting the treatment they need.

Despite sky-high premiums that relentlessly rise every year, we’re learning that insurance companies are blockading access to health care for their policyholders more than ever.

The Doctor-Patient Rights Project got a polling firm to research just how widespread barriers to receiving treatment have become for insured Americans. The results they found confirmed that many insurers are systematically restricting access to treatments and medications ordered by medical professionals.

Not a pretty picture

Denying, delaying and substituting doctor-ordered treatments has become extremely routine for insurance companies. In fact, the study found that “one in four patients with a chronic or persistent illness or condition” has been denied treatment coverage by insurance providers.

This study also points out that the majority of these people who face treatment denials have serious conditions, and that one-third of those who were denied treatment saw their health worsen because of the insurance companies’ unwillingness to pay.

In essence, health insurance companies, to save money, are overriding doctor’s orders and getting away with it.

Insurers send patients and medical providers through a bureaucratic maze that’s designed to block you from getting medications and treatment plans you need. In countless cases, patients get sicker and sicker as their insurance companies refuse to cough up the dough.

What are some tactics being used by insurance companies?

The most common practice that’s used to get between you and your doctor is called “prior authorization.” This practice mandates that the physician ask the insurance company for permission to “cover a particular medication or procedure.” That’s right — your doctor, who spent years in medical school, often has to ask a pencil pusher with no medical training to allow them to prescribe a medication or procedure.

Another standard practice is “step therapy,” which mandates that doctors should try a series of “less expensive drugs” on you and make sure they don’t work before you get what you need. There’s also “non-medical switching,” whereby insurance companies tell pharmacists to give you a cheaper drug, even if it is an entirely different medication with a different formula.

In other cases, some insurers overtly exclude medications from your coverage, or do “adverse tiering placing,” meaning that you’ll face higher co-payments for more expensive drugs that are used to treat certain conditions such as HIV or Hepatitis C.

What can be done to stop this disturbing trend?

People who face insurance denials are often very ill and feel powerless when they can’t get access to the treatment they so desperately need. But now, it’s more important than ever that everyone speak up about these unfair practices.

When dealing with insurance companies, it’s critical that you be your own advocate and continue to pester them to approve your doctor-ordered treatment requests. In many cases, you can get what you need if you continue to drill them.

Insurance companies are businesses and worry about their reputations like anyone in the private sector. When you’re given the runaround and denied treatments or medications, remind them that you’re not afraid to tell your story on social media.

Takeaway: Health care is a mess in America

This latest study confirms many of our worst fears — insurance companies are routinely getting in the way of the doctor-patient relationship to turn a profit. Add this to an eye-popping number of issues that we’re seeing in our ailing system of health care in America.

Unfortunately, the last attempt at overhauling health care by the Obama administration didn’t address the biggest problem in health care: the growing cost of care.

Meaningful health care reform is needed to contain the growing cost of care and all of the issues associated with it, including out-of-control Medicaid spending, runaway drug prices and routine denials by insurance companies.

Until politicians put their big-kid pants on and push through effective health care reform, be prepared to fight your insurance company to get the coverage that you’re already supposed to have.

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Header image:  Adobe Stock

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