.png)
Got Denials? Fight Back
Speaking of unreasonable coverage denials, Alex J. Brown, a partner at Shapiro Sher and chair of the firm’s Insurance Law Practice Group, proposes a change in the law to empower patients in their ongoing fight against insurance coverage denials. In a Baltimore Sun opinion piece, Brown tells the story of his client that successfully defeated an insurance denial of a necessary prosthetic knee.
“While my client technically “won” the case, the ordeal took a toll. As everyone knows, fighting with insurance companies can be time-consuming and emotionally draining, especially when one is coping with a traumatic injury or catastrophic illness. Furthermore, my client had to pay legal fees for representation before state regulators.”
And the cost to the insurance company? Nothing.
The deck is currently stacked against patients. Patients incur the entire toll of battling an insurance company, with no risks or cost on the insurance side. That’s why Brown suggests a law that would even the playing field by penalizing health insurers that deny claims in bad faith.
“Unfortunately, our current system allows health insurers to refuse coverage as a matter of course without threat of penalty. This is not the case when it comes to auto and property insurance. In Maryland, insurers who deny valid claims for coverage under auto or homeowners’ policies can be fined by state regulators for acting in bad faith. Current statutes do not allow for such fines in the case of health insurance.”
It’s time that we reform our health insurance rules to match other insurance industries. Does it make any sense that you have more rights to replace your car than a medical treatment that could save your life?
Human Trials for Huntington’s Treatment
We love starting our Friday off with good news of innovation for patients. Sarah Knapton, Science Editor at the British newspaper, The Telegraph, writes that a new treatment to reverse Huntington’s disease has entered human trials after a series of successful tests in monkeys and mice.
The new treatment IONIS-HTTRx “silences the gene known to be responsible for the production of a protein which causes Huntington’s.”
“It is very exciting to have the possibility of a treatment that could alter the course of this devastating disease,” Dr. Blair Leavitt of the University of British Columbia in Vancouver tells The Telegraph. “Right now we only have treatments that work on the symptoms of the disease.”
Drug Addiction vs. Bureaucracy
The New York Times looks at the regulatory hurdles that are impeding treatments for those addicted to prescription drugs. Fewer than 32,000 doctors out of one million U.S. physicians are legally allowed to prescribe buprenorphine, one of the most effective treatments for opioid addiction.
“Doctors may prescribe it only after taking an eight-hour course and applying for a special license,” explains Austin Frakt, a health economist who blogs at The Incidental Economist. “No such hurdles are required for prescribing any opioid painkillers…Many doctors are reluctant to prescribe buprenorphine; only 2.2 percent have met the regulatory requirements.”
Since 2000, the number of deaths from opioid painkillers and heroin has tripled. We need to streamline regulations for all drugs to get valuable treatments, such as buprenorphine, to patients sooner.
Insurers Probed on Hepatitis C Drug Coverage
Bloomberg’s Zachary Tracer and Caroline Chen report on the New York State Attorney General’s investigation into insurance companies that have denied coverage of Hepatitis C treatments.
“The New York state attorney general has asked 16 health insurance companies for information on their coverage of hepatitis C treatments, amid concerns that some companies are restricting coverage of the expensive medications, according to a person familiar with the investigation. Several health insurers, including Aetna Inc. and EmblemHealth Inc., confirmed they were part of the probe.”
