Missourians want answers when insurers deny coverage of doctor-prescribed treatments

Although the election season is over, it wouldn’t be complete without another opinion poll, only this one will still matter long after Nov. 8. With the votes cast, those who promised change must focus on the the big problems and necessary solutions that will most affect the lives of Missourians.

According to a recently released national and statewide survey from the Partnership to Fight Chronic Disease, 46 percent of Missouri residents have seen their health care costs increase in the past year.

The news gets worse. Almost one-third say coverage for them is not only getting more expensive, it’s getting worse. Nationally, 77 percent of Americans polled said they or someone they know had difficulty using their health insurance in the past year.

Clearly, patients aren’t getting what they’re looking for from the institutions that claim to serve them.

While many are focused on drug prices, there is an even more serious crisis at hand: the denial of essential medications prescribed by doctors.

It is true — a doctor can prescribe a treatment he or she deems necessary or even vital, a patient can agree, and a pharmacy benefit manager can overrule them both. Insurers are operating under the belief that it is acceptable to allow patients to fail first or become sicker on a lower-cost medication before agreeing to provide drugs their doctors had prescribed.

Everyone knows someone in need of daily medication. The expenses can be high. But what economic theory justifies the denial of life-saving cures because one medication costs more than another?

The survey revealed that an alarming 20 percent of Missourians say the treatment their doctor recommended wasn’t covered by insurance, while 21 percent say the treatment of someone they know had the same problem. An eye-opening 88 percent of Missourians declared as very or somewhat important the need for transparency regarding how and why health plans are deciding to deny coverage of doctor-prescribed treatments.

Even more challenging, patients often accept their insurer’s judgment and don’t pursue administrative appeals. People fighting for their lives don’t often look to open up another front in another war.

Denying vital medications could have serious consequences; who is responsible when this occurs? Doctors are required to take an oath to do no harm; should insurers be asked to do the same?

Fundamentally, this isn’t just the patient’s fight, or only their doctor’s cause. The advocacy community must lend its voice of concern to this policy problem, insist on comprehensive reform and bring an end to health care’s secret scandal. And lawmakers must listen.

Given this data, it really isn’t a surprise that Missourians believe their insurers are failing them. According to the partnership’s poll, Missourians say the top health care priorities for politicians and government officials should be managing premium increases, lowering co-pays and deductibles, and holding insurance companies accountable.

It’s time to put patients first and make health care, medicines and treatment easy and accessible. There is no humane reason health insurers should inhibit the decisions of doctors, and there is no excuse for denying vital medications while patients become sicker and their lives remain in the balance.

How did the most vital medical decisions in your life go from the expert in the white coat to the bureaucrat in the gray flannel suit? As the survey shows, it’s a question an awful lot of Missourians are asking as well.

This story was originally published November 20, 2016 at 2:00 PM with the headline "Missourians want answers when insurers deny coverage of doctor-prescribed treatments."