It’s time insurers put patient access to quality health care ahead of profits
By Jim Manley
When a U.S. District judge ruled that UnitedHealth Group developed policies discriminating against patients with mental health and substance abuse disorders in an attempt to save money, patient advocacy groups rightly cheered the decision. Those with mental health and substance abuse disorders deserve and depend on access to affordable, quality care, and these practices are simply appalling. The fact that insurers have been able to restrict or deny coverage for treatment to people in need — despite the federal law that requires comparable coverage for mental health and other health issues — is unacceptable and must be addressed.
The ruling is undoubtedly a step in the right direction, but there is still work to be done. A recent Ipsos-Consumers for Quality Care survey found Americans are deeply frustrated by unpredictable costs and the lack of transparency in health care. Practices including insurers with narrow networks and emergency room denials that lead to surprise medical bills and shift more and more costs to consumers are at the root of much of that frustration.
According to the survey, more than half of Americans say networks are too narrow, covering too few doctors and specialists. Still, nearly three-quarters of health plans on the ACA’s exchange market have narrow networks. This is a significant problem for consumers, particularly those with chronic conditions. In some instances, insurers are using deceptive marketing tactics to mislead consumers into believing that they are well-covered, when in reality, they are signing up for extremely narrow networks. Last year, the insurer Centene was the subject of a lawsuit alleging that the company’s Ambetter brand’s slim coverage made it difficult, if not impossible, for consumers to find adequate care. In some instances, the company even went so far as to list doctors as taking its coverage when they often didn’t.
A recent study by the California Chronic Care Coalition brought to light the extent that insurers inappropriately deny patients the treatments prescribed by their doctors. The research shows that more than 60 percent of the insurance denials brought before the Department of Managed Health Care for review were overturned or reversed. At the emergency room, too, patients across the country are feeling the burn of harmful insurance practices aimed at maximizing profits. A dangerous practice that forces policy-holders to pay for an emergency room visit if the insurance company later deems it a “non-emergency” is being implemented in several states. In an emergency situation, it is impossible for consumers to know if their problems are life-threatening or not. Determining whether chest pain is a heart attack or a migraine the result of a stroke is a decision for a medical expert. No patient should be forced to act as their own doctor and attempt to self-diagnose to avoid incurring medical bills, but this policy does just that and puts patient lives at risk.
There is no shortage of insurer practices that can leave consumers facing surprise medical bills despite the monthly premiums they pay to be covered when they need it most. With recent research showing that fifty-seven percent of Americans have received a surprise bill at some point, lawmakers are attempting to address the problem through federal and state legislation. As an organization committed to providing a voice for consumers in the health care debate, we are encouraged by this state and federal action, but urge insurers to do what’s right and put an immediate end to these practices to ensure that Americans are able to access the care they need.
Jim Manley is a former senior adviser to Sens. Harry Reid (D-Nev.) and Edward Kennedy (D-Mass.). He now serves on the board of directors of Consumers for Quality Care, a coalition of health advocacy organizations and former policy makers working to provide a voice for patients in the health care debate as they demand better care.
