For thousands of Rhode Islanders suffering from chronic and persistent illnesses, access to quality, affordable medical care is essential to their overall health. Yet, patients with chronic conditions have a one-in-four chance of being denied treatment coverage by their insurance provider, according to new polling data. Even if Congress cannot agree on how to reform our nation’s health care system, Rhode Island’s political leaders can agree that patients should get the health insurance they have paid for.
Almost half of all Americans live with a chronic disease, an illness that develops over time and generally requires ongoing treatment. In 2015, for example, almost 51 percent of Rhode Island’s Medicare recipients were suffering from high cholesterol, over 57 percent were treating hypertension and more than 29 percent were living with arthritis.
A national survey by the Doctor-Patient Rights Project, a coalition of patients, physicians, companies and advocacy groups, found that 24 percent of patients with chronic illness have been denied insurance coverage for treating their conditions. Nearly 60 percent have been denied multiple times.
For many patients, being denied coverage means watching their health deteriorate even further. Treating chronic conditions requires continuous costs for treatment copays and deductibles, even for patients who have insurance. When insurers refuse to cover these treatments, however, many patients forgo treatment altogether rather than pay out-of-pocket costs that could bankrupt them.
Chronically ill patients who forgo or skip treatment face serious consequences to their health. Over 70 percent of the patients DPRP surveyed who were denied treatment described their chronic conditions as “serious,” and 43 percent said they were generally “in poor health.” For these patients, over one-third (34 percent) said their insurance provider’s denial of coverage forced them to skip treatment, and nearly one-third (29 percent) said their condition worsened.
In general, the chronically ill tend to be poorer and older than other patients. They also may be more likely to face a denial of treatment coverage from their insurers. DPRP’s survey found that, though only 42 percent of patients aged 18-29 were denied coverage of a prescribed medication, 70 percent of those aged 65 or older were denied.
Because of their income level and age, moreover, chronically ill patients denied treatment coverage not only makes them more likely to have to sacrifice their treatment, but more susceptible to negative health effects when they do.
While a growing number of these patients say their insurers will not pay for treatments, federal and state governments have not conducted much research to assess the overall incidence of treatment denials and their impact on the health of patients. In 2011, the federal Government Accountability Office performed a limited analysis of claims denials by insurers in six states because there were only six that even collected such data. The GAO’s analysis found that the rate of treatment denials varied between 6 percent and 40 percent, depending on the company.
The federal government has yet to update those numbers or perform a comprehensive evaluation of coverage denials in all states. At the very least, DPRP’s nationwide findings reveal a hidden health care crisis among insured patients throughout the nation, and a serious need for Rhode Island’s leaders to investigate insurance company treatment denials in the state, particularly of the chronically ill.
Patients with chronic conditions that honor the contract, dutifully pay their health insurance premiums and meet their deductibles should not have to worry that their insurance provider will deny coverage when they need it most.
Seth Ginsberg is president and co-founder at the New York-based Global Healthy Living Foundation, and a founding member of the Doctor-Patient Rights Project, in Washington, D.C.
