
- Step therapy is the practice in which patients are forced to try cheaper treatments before they are allowed to try more expensive ones, even if their doctors are confident the less expensive treatments will not help them. It’s one way insurance companies are trying to keep their profit margins high, even if it means creating obstacles for patients trying to get the health care their doctors have prescribed. For example, a woman with lupus suffered severe vision problems after an insurer made her try multiple medications before it would pay for one that her doctor originally prescribed. In another case, a lung cancer patient took a break from what had been a successful chemotherapy regimen, and when she needed to go back on it her insurer would not let her resume treatment until she tried other, cheaper drugs. Read more
- In another move to avoid covering people with chronic or preexisting conditions, insurance companies have been rejecting patients who rely on financial aid programs offered by charities and nonprofits. They have even been putting language to that effect in their plans filed with state insurance divisions, and they have lobbied the federal government on the issue as well. As insurance companies pay for less and less and consumers foot ever-growing bills, many patients look to outside financial aid to help them afford their care. The Minnesota Commerce Department recently looked into this issue after Blue Cross of Minnesota attempted to reject third-party payments from nonprofits providing financial aid to patients struggling to pay their health plan costs. Daryl Lebahn of Blaine, Minnesota, was among those patients. He “wouldn’t be alive today without dialysis treatments”, and he relies on help from the nonprofit American Kidney Fund to pay his bills. Many others, with many other diseases, rely on similar programs to maintain their access to health care. “If it wasn’t for their help, a lot of people – I don’t know what we’d do,” Lebahn told the
- Similar to bans on charitable premium assistance, insurers are increasingly looking to move chronic disease patients off their plans by rejecting co-pay assistance programs. For example, Colin Smith, of Kuna, Idaho, has multiple myeloma, a type of cancer that forms in plasma cells and has required him to undergo two radiation treatments and a stem-cell transplant.
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- Sometimes, health insurance companies will look at a certain chronic condition and target associated health care providers. For example, in Idaho, a woman named Debbie Birch was diagnosed with end-stage renal disease and needed kidney dialysis to survive. Her insurance company, Blue Cross of Idaho, refused to provide dialysis treatment in-network – despite the fact that Debbie and her husband and paid for their insurance. Read more by