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When Insurance Companies Say No

NPR, the Kaiser Family Foundation, and the Harvard School of Public Health recently published the results of a telephone survey on the health care delivery system in the U.S.

Among the questions asked was whether a patient had their doctor's recommended treatment denied by their insurance company.

In the past year, has a doctor ever recommended a treatment or prescription drug for you, but you found out your insurance company wouldn't pay for it, or hasn't this happened?

The graphic below shows the distribution of responses.

40% of those who had the recommended treatment declined went without treatment or had to pay for it themselves.

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In an abcnews.com story Cynthia Toussaint recounts how her insurance company said no to the prescribed drugs that were working at the time:

"Eighteen years ago, my insurance company switched me from Axid, which I was using to treat CRPS in my vocal cords, to a cheaper medication," she recalled. "As a result, I couldn't speak and even experienced pain when whispering. I was forced to 'fail' on two cheaper medications before getting the medication my physician originally prescribed."

Toussaint said that she had a similarly negative experience when her insurance company switched her off her brand name Klonopin -- a pain and anxiety drug -- to a cheaper alternative that left her in pain and experiencing hallucinations.

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NYTimes.com tells of a husband and wife who have been looking for insurance for their 21-year-old son with metastic testicular cancer. Although he has been cance-free for a year the cost of regular monitoring is making finding insurance a tough road. Because the family owns their home the federal government says no to any federal subsidized insurance plan.

Neither of the Walkers has been able to land a job with the kind of large group coverage that would disregard Jake’s health status. His cancer history effectively makes him uninsurable on the individual market. He is too old to qualify for Medicaid as a child, and it is virtually impossible in Texas to qualify as an able-bodied adult.

Posted by: Staff on April 23, 2009
Category: Cancer; Health Disparities; Health Equity; Healthcare Costs; Universal Health Care; health insurance