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National View: Minnesota's chronically ill risk being denied treatment coverage

For thousands of Minnesotans 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.

Kelli CarlsonEven if Congress cannot agree on how to reform our nation's health care, Minnesota's political leaders can agree that patients should get the health insurance they pay for.

Almost half of all Americans live with a chronic disease, an illness that develops over time and generally requires ongoing treatment. In 2015, over 30 percent of Minnesota's Medicare recipients were suffering from high cholesterol, 43 percent were treating hypertension, and nearly 24 percent were living with arthritis.

Seth GinsbergA 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 illnesses have been denied insurance coverage for treating conditions. Nearly 60 percent of those patients were denied multiple times.

For many patients, being denied coverage means watching their health deteriorate. Treating chronic conditions requires continuous costs for treatment co-pays and deductibles, even for patients who have insurance. When insurers refuse to cover these treatments, many patients forgo treatment 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 patients the Doctor-Patient Rights Project 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 a third (34 percent) said their insurance provider's denial of coverage forced them to skip treatment; nearly a 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. The 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 being denied treatment coverage makes them not only 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 its 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 office'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, the Doctor-Patient Rights Project's nationwide findings reveal a hidden health care crisis among insured patients throughout the nation — and a serious need for Minnesota's leaders to investigate insurance company treatment denials in our state, particularly of the chronically ill.

Patients with chronic conditions who 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.

Kelli Carlson of Woodbury, Minn., has lived with rheumatoid arthritis since she was a teenager. She is a patient advocate for the Global Healthy Living Foundation (ghlf.org), which is a founding member of the Doctor-Patient Rights Project (doctorpatientrigthtsproject.org). Seth Ginsberg of Upper Nyack, N.Y., is the Global Healthy Living Foundation’s president and co-founder and is a member of the Doctor-Patient Rights Project. They wrote this specifically for the News Tribune.

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