When insurers put profits over patients: A look at insurance discrimination in 2019

12.24.19

Chronic disease patients spend much of their time fighting discrimination at school, in public, at their workplace or even in the insurance office. Diagnosing, treating and living with a chronic condition is costly, and insurance companies often employ deceptive, money saving practices and protocols to protect their bottom line, usually at the patients’ expense. This week’s blog looks at three times insurers put profits over patients in 2019, and how patients were able to fight this discrimination.

Hospitals made $21B on Wall Street last year, but are patients seeing those profits?

An article from NBC News in September highlighted the profitability of the hospital system, but economic analysts reveal that the profits of this industry are not going towards lowering the cost of health care.

“When health care costs more, that means health insurance premiums are higher and when premiums are higher, employers pay more,” Martin Gaynor professor of economics and health policy at Carnegie Mellon University says in the article. “Employees indirectly pay for most of that,” he said, either by receiving less in wage increases than they would otherwise, or shouldering higher premiums, deductibles and co-pays. “All of those things have been happening.”

The article stresses how rising health care costs have thrust this issue into the eyes of the public, especially recently. Unfortunately, the brunt of these rising costs is felt by chronic disease patients, mental health patients and those utilizing government health plans

No simple answer is outlined in the NBC News article; however, experts point out that this new discussion on affordable and accessible health care will dramatically impact the way Americans get and pay for care in the coming years. Using the power of advocacy, chronic disease patients can reveal the impacts of rising health care costs to effectively change the health care industry for decades to come.

Cancer patients are being denied drugs, even with doctor prescriptions and good insurance

Many local news publications featured insurance discrimination stories throughout the year, but one of the more notable stories came from a Fresno Bee story about retired special education teacher Norma Smith’s cancer diagnosis.

Smith was diagnosed with stage-three cancer in December last year, the article reads. Smith’s aggressive form of blood cancer quickly moved to her bone marrow forcing doctors to act fast. But as Smith prepared for treatment, her medication was denied for not following the standard sequence of medications that her pharmacy manager, CVS Caremark, required. This process is also known as step therapy and can heavily delay successful treatment options.

“Every time we want to make a change (to medications), we have to go through this whole process where someone – and we don’t know who it is – someone has the right and authority to override my judgment and what the patient needs,” said Smith’s oncologist, Dr. Ravi Rao, of Care Cancer Center in Fresno.

This sort of discrimination is all too common for chronic disease patients. Fortunately, bringing these cases to light and standing up to your insurer can be a successful way to gain financial coverage for sometimes uncommon treatments.

‘UVA Has Ruined Us’: Health System Sues Thousands of Patients, Seizing Paychecks and Claiming Homes

An article from Kaiser Health News earlier this year outlined a different kind of insurance discrimination, a lawsuit aimed at patients. The University of Virginia Health System has recently sued dozens of patients some for as much as $1 million. But this isn’t new for UVA Health, the insurance company has seized $22 million in state tax refunds owed to patients with outstanding bills over the past six years.

This bill collection has driven patients to lose their homes, not pay their electric bills and in some cases cause marital turmoil. The article looks at the story of Heather Waldron and John Hawley a couple that faces a lawsuit and a lien on their home to recoup $164,000 in charges for Waldron’s emergency surgery in 2017.

Following the lawsuit, the family was worried about financial disaster preparation and bill payment, contributing to their divorce, the article reads. This sort of financial and marital distress exemplifies the far-reaching impacts of profit driven insurance policies. Sadly, this profit prioritization is not just affecting the Waldron, Hawley family, but also families across the nation.

2019 brought the health care discussion center stage as chronic disease and patients’ rights advocates everywhere shared their stories about working with insurers and being denied coverage. This advocacy is what will dismantle insurers’ profit driven agenda and end discriminatory, special interest legislation that allows insurers to put profits over patients.