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Many Americans are highly concerned with access to affordable and quality health care. And rightfully so with the price of premiums rising as they are. What many American’s don’t realize is that even if you can afford insurance, your access to quality health care can be restricted by insurance company tactics that limit coverage for certain prescriptions and procedures.

That’s right. The doctor that you seek out when you’re sick, share your health with, and trust: They may not have full reign when working for you, as the patient. The medical middleman has come between doctors and patients. As healthcare costs have risen, insurance companies have increasingly used their power as payers to alter doctors’ prescriptions and override patients’ treatment decisions.

The Doctor-Patient Rights Project (DPRP) recently did a study that showed the health of nearly one in four insured patients, that’s almost 53 million Americans, treating a chronic or persistent illness may be in jeopardy by insurance providers to denied coverage. One-third of these patients cannot afford the out-of-pocket costs and may be forced to put off or forgo treatment altogether.

Of course the power should be in the hands of the doctors not insurance companies. The good news is that there is a way to fight back.

In many cases insurance companies are essentially practicing medicine when they deny commonly accepted treatments as “experimental” or refuse without good cause to approve a surgery at all.  In a recent case a family won more than $25 million in a lawsuit against Aetna for not approving care.  A law firm we work with is pursuing a case currently against United Health Care for something similar.

In that case it’s alleged that a sick person called the toll free line for the insurance company and spoke to a “nurse” who allegedly assured him that despite shortness of breath and difficulty breathing he was fine.  The reality is that the proper advice would have been to tell them to hang up the phone and rush to an ER or call 911.  This has resulted in a wrongful death lawsuit against the health insurance company.

This was the insurance company allegedly practicing medicine and giving bad advice.  With some insurance companies approvals and denials are made by people with limited to no medical training.

Doctors should have the power to make treatment decisions without interference from insurers and if you call an insurer they should always err on the side of your health and not their bottom line. This isn’t the case as recently we’ve seen a cancer patient denied specialized treatment, a diabetic denied vascular surgery, a child with a brain tumor denied specialized marrow transplantation and/or chemotherapy, a man with brain cancer denied testosterone.

When this type of insurance company malpractice happens, you may have a lawsuit.  Contact us any time for free if you’d like to discuss your options.