Report: State Laws Aren’t Stopping Health Insurers From Denying Claims
ProPublica explains that hundreds of consumer protection laws that are supposed to mandate what insurers must cover aren't working, as health plans violate them. A case where Cigna denied coverage for a double-lung transplant to a lung cancer patient is also reported.
ProPublica:
Health Insurers Are Denying Claims Despite Breaking State Laws
Over the last four decades, states have enacted hundreds of laws dictating precisely what insurers must cover so that consumers aren’t driven into debt or forced to go without medicines or procedures. But health plans have violated these mandates at least dozens of times in the last five years, ProPublica found. ... On Wednesday, a ProPublica investigation traced how a Michigan company would not pay for an FDA-approved cancer medication for a patient, Forrest VanPatten, even though a state law requires insurers to cover cancer drugs. (Miller and Fields, 11/24)
USA Today:
Cigna Denies Vanderbilt Lung Transplant For Cancer Patient
A large health insurance company said it made an error when it denied coverage this week to a 47-year-old woman as she prepared to undergo a double-lung transplant to treat her lung cancer. The woman, Carole Taylor, was summoned to Vanderbilt University Medical Center Tuesday when the hospital found a donor match for a double lung transplant. As the transplant team prepared her for the procedure, she was informed the insurance company, Cigna Healthcare, had denied the transplant. Instead of getting a pair of donor lungs, Taylor was sent home and deactivated from the transplant waitlist. (Alltucker, 11/24)
On Medicare Advantage —
Politico:
'It Was Stunning': Bipartisan Anger Aimed At Medicare Advantage Care Denials
Enrollment in Medicare’s private-sector alternative is surging — and so are the complaints to Congress. More than 30 million older Americans are enrolled in Medicare Advantage plans, wooed by lower premiums and more benefits than traditional Medicare offers. But a bipartisan group of lawmakers is increasingly concerned that insurance companies are preying on seniors, and, in some cases, denying care that would otherwise be approved by traditional Medicare. (King, 11/24)
Modern Healthcare:
Medicare Advantage Marketing Limits Could Shake Up Markets
Stricter rules governing Medicare Advantage marketing may offer smaller health insurance companies an opportunity to snatch market share from dominant players such as Humana and UnitedHealthcare. Large health insurance companies have employed generous and creative broker and agent compensation strategies to gain and hold members. Some smaller rivals that may lack the resources to match that approach believe limits the Centers for Medicare and Medicaid Services wants to establish on those practices could benefit them. (Tepper, 11/22)
In other health care industry news —
The Wall Street Journal:
Hot Healthcare Hiring Bolsters Cooling U.S. Labor Market
A healthcare hiring boom is helping offset weaker job growth in other areas of the softening U.S. economy, boosting its chances of skirting a recession. The industry could serve as a strong job generator for years to come as an aging population and Covid-19 fuel widespread worker shortages and greater needs for healthcare services. (Guilford and Rubin, 11/26)
Bloomberg:
Amazon Bets On One Medical After Past Health-Care Initiatives Sputter
Amazon.com Inc.’s Prime membership program began with speedy shipping, then video streaming. The latest perk—discounted access to a virtual doctor—is being pitched as another win for customers: medical care delivered as seamlessly as tube socks and television shows. But it’s a capitulation of sorts. Having spent almost a decade and billions of dollars trying to re-invent American health care, Amazon has settled on a decidedly traditional approach. (Day and Bennett, 11/27)
