Why don’t insurers follow doctor’s orders?

Paul Gileno

The election has concluded and lawmakers are quickly exploring options to repeal the Affordable Care Act.

While there is a notable outcry regarding the recent announcement that premiums for plans under Obamacare will rise by an average of 25 percent next year, there is a much more serious issue facing Americans.

It’s an insurer maneuver that denies patient access to life-saving treatments.

Let’s be honest, premium hikes would be justified, (at a reasonable level), if you got more bang for your buck. The unfortunate truth is that consumers are receiving less coverage for their money, fewer choices and being denied much needed therapies, despite paying premiums. Even if you are eligible for subsidies to bring down the price of your insurance, it still won’t help you obtain access to medications.

Whereas the average premium in Michigan will increase 7 percent, the next time Michiganians try to fill a prescription at the pharmacy they may find something worse — the insurers they are paying have no obligation to follow their doctor’s decisions. Patients may also find that insurers are opting to override their doctor’s suggested prescription in favor of a less expensive treatment option, regardless of its efficacy. This is one of many reasons consumer distrust toward health insurers is growing — and rightfully so.

Day in and day out the health care conversation is continually directed to drug prices, which is what insurers are hoping Michiganders will focus on, rather than examining a practice that is more dangerous to consumer health.

The only person I want making my health care decisions is me, under the guidance of my doctor. The insurer has no place in the examination room. We trust our doctor to be the arbiter of our health and patients want to know when they walk into a doctor’s office they are going to receive the best available care determined by their physician, not their insurer.

Insurer obstruction in medical decisions will only worsen unless lawmakers take action. Insurers have conveniently situated themselves in the middle of the sacred physician-patient relationship, altering treatment plans to save money while disregarding the professional opinion of the prescribing doctor.

Health insurers can now unilaterally decide not to cover these drugs without any oversight and with little transparency, but that is not what Americans want. The vast majority of Michiganders may find that insurers are not upfront with their practices and that patients must insist upon transparency regarding which medicines are covered by their insurance plans.

Insurer interference at the price of a patient’s health cannot be allowed to continue. The consequences are far too dangerous to risk. We all want our doctors to prescribe what is medically necessary and not what is perhaps the less expensive therapy.

It is also time for lawmakers to make these practices illegal and focus on the real issue at hand. We must voice our concerns regarding these nefarious practices which focus on fiscal outcomes rather than saving lives. Health insurers are supposed to be insuring our health, not taking unmitigated risks.

We need our lawmakers to call these practices into question and insist Michigan residents are provided with the care and treatments recommended by doctors. It’s time to stop insurers from playing a lead-role in determining which treatment plan is best for patients.

Paul Gileno is president and founder of the U.S. Pain Foundation.