'Hidden' crisis: Many patients with chronic illnesses find insurance providers deny treatment, new survey says

Health insurance benefits form
Doctors, not insurance providers, should decide treatments for patients, say 91% of respondents in a new poll. (Getty/michaelquirk)

The real crisis in healthcare isn’t getting more people covered. It’s getting insurers to pay to treat chronic illnesses, according to a new healthcare advocacy group.

More than 50 million Americans with health insurance may lack access to treatment for chronic diseases because their insurance provider denied them coverage, a survey (PDF) commissioned by The Doctor-Patient Rights Project (DPRP), a nonprofit coalition of doctors, patients and others found.

The nationwide survey of 1,500 people covered by employer-sponsored health insurance, Medicare or Medicaid, was conducted in March.

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Of those surveyed, 69% said they had been prescribed a medication, undergone a diagnostic or screening test, or undergone a medical procedure to treat a chronic or persistent medical illness or condition. Of those, 24% reported their health insurance provider denied coverage for the medication, test or procedure.

Of those who said they were denied, 70% sought treatment for “serious” chronic or persistent health conditions and 43% were patients described as “in poor health,” the survey found.

And 29% said they saw their health deteriorate as a result, even if they eventually convinced their insurer to cover treatment.

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“Our research reveals a hidden healthcare crisis,” Stacey Worthy, executive director of Aimed Alliance and one of DPRP’s founding members, said in an announcement. “The current debate about healthcare reform has focused on getting more Americans covered. Yet, the real crisis is among patients with chronic illnesses who tell us that insurance is worthless when their insurance providers withhold coverage of essential treatments prescribed by a doctor.”

Other results of the survey included:

  • Almost 2 out of every 3 patients denied coverage were denied multiple times and most had to wait more than a month before their insurance provider responded to their request for a prescribed treatment.
  • More than one out of every three patients (34%) denied coverage had to put off or forego treatment altogether.
  • Most patients (91%) said insurance providers should not have the final say in treatment decisions and 87% said insurers should pay either a secondary role or no role at all in deciding medical treatments.

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“Insurers that deny patients coverage for a prescribed treatment are effectively overriding the judgment of the treating physician,” said Theresa Rohr-Kirchgraber, M.D., past president of the American Medical Women’s Association.

Insurance providers are often seen—even by those satisfied with their insurance—as only caring about profits. But patients who are denied coverage have even worse perceptions, according to the report.

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