Health Insurance Barriers Increasingly Put Patients in Precarious Position According to SCMA Physicians Survey

Statewide Physicians Group Cites Protocols That Negatively Impact Ability to Provide the Ultimate Level of Care

COLUMBIA, S.C.--(BUSINESS WIRE)-- Restrictions from health insurers are greatly interfering with the physician-patient relationship and the ability of the physician to administer the care he or she was trained to provide, according to a survey that was released today by the South Carolina Medical Association. Alarmingly, physicians reported pressure to change treatments based on cost considerations rather than what may be best for their patients.

“The practices that insurers utilize are interfering with the patient-physician relationships and hinder the ability of South Carolina residents to promptly receive sufficient healthcare,” said Todd Atwater, SCMA Chief Executive Officer. “Not only do these practices discriminate against those with limited resources, but the practices are cumbersome for all parties involved. These added barriers have associated costs that are weighing down an already overburdened system”

Specifically, the survey cites practices, such as therapeutic switching, step therapy protocols and pre-approval requirements, which are intended to contain costs, but actually require physicians and patients to complete, and often repeat, one or several tasks before having the ability to receive treatments already prescribed by a physician.

Some of the survey’s findings include:

■ An overwhelming majority (95 percent) responded that they had changed the way the treated a patient based on restrictions from an insurance company.

■ Ninety-Seven percent responded they had to change a prescription medication due to restrictions imposed by an insurance company

■ Eighty-nine percent agreed with the statement, “I feel that sometimes I am being pressured to prescribe a course of treatment based on cost rather than on what may be best for the patient.”

■ Ninety percent do not believe communication from insurance companies to patients is accurate, fair and provides an unbiased side risk/benefit profile when communicating to patients requesting a change to their treatment as prescribed by their physician.

■ Ninety-one percent believe there should be enforceable legislation regarding restrictions that insurance companies put on physicians.

In conjunction with the release of the survey results, The SCMA is soliciting real-life stories from its members that can be shared with the public and with legislators to demonstrate the impact these barriers are having on South Carolina patients. These testimonials will be incorporated into a campaign that will be launched in early 2011 to more fully educate the public and lawmakers about what can be done to reverse this troubling trend.

"As South Carolina deals with the implications of the recently passed federal health care overhaul, it is imperative that we take a second look at pre-approval requirements, step therapy protocols and therapeutic switching policies in order to ensure that all South Carolinians have the protected relationship with their doctor that they deserve. If not, we are in danger of having medical decisions made by insurance companies rather than physicians,” concluded Atwater.

For the complete results of the survey, please contact the South Carolina Medical Association.

About the South Carolina Medical Association

The SCMA, comprised of nearly 6,500 physicians, was founded in 1848 and is the voice of the medical profession in South Carolina. Its purpose is to support the efforts of South Carolina physicians and to advocate for quality medical care and good health on behalf of the citizens of South Carolina, as well as to represent and serve the interests of physicians.


South Carolina Medical Association
Kate Crosby, Director of Communications, 803-798-6207, ext. 228,
[email protected],

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