Health insurer denials may be making Americans sicker


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Health insurers are rejecting patient claims that deny them access to vital medications. Some of those patients may end up sicker, suggests a recent survey. Health insurers denied coverage for nearly a quarter of the Americans with chronic conditions or persistent illnesses. In a third of the cases, these patients, all of whom had insurance coverage, said their conditions worsened after being rejected.

Health insurance is designed to cover patients when they get sick, but what happens when insurance companies stamp "reject" on a claim?

Some of those patients may end up sicker, suggests a recent survey entitled "Not What the Doctor Ordered" from the Doctor-Patient Rights Project (DPRP). Health insurers denied coverage for nearly a quarter of the Americans with chronic conditions or persistent illnesses. In a third of the cases, these patients, all of whom had insurance coverage, said their conditions worsened after being rejected.

A spokeswoman for America's Health Insurance Plans (AHIP), a trade association representing 1,300 health insurers, took issue with the study. "It's a political campaign by Big Pharma to drive up the cost of drugs," said spokeswoman Cathryn Donaldson.

The DPRP study claims the insurance appeals process doesn't work in many cases. Less than half were successful in their appeals, and 50 percent of those denied were turned down multiple times. As a result, more than a third either put off or had to forgo treatment altogether. Nearly a third of patients saw their conditions worsen, even if their insurer eventually provided coverage for treatment.

"The most vulnerable patients were likely to experience a coverage denial," according to the study.

"Patients with chronic illnesses tell us that insurance is worthless when their insurance providers withhold essential treatments prescribed by a doctor," said Stacey Worthy, executive director of the Aimed Alliance, a non-profit group that promotes health care. She is also one of DPRP's founding members. In fact, nearly two-thirds of patients felt insurance providers "are currently failing their customers," the study claimed.

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Source: CBS News

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