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Sun Sentinel: Health insurers' Rx denial hurts Florida businesses
Business owners invest in quality health insurance because they want happy, healthy employees, who can show up on time and put in a productive day’s work. When insurance companies constantly look for ways to deny employees essential treatments, they undermine business investment and impede economic growth. Our policymakers at the state and national level should view health care reform as a crucial part of workforce development and stop insurers from blocking employee access to the best treatments.
Insurers regularly require doctors to obtain prior authorization for certain medications, even when the prescribing doctor has examined the patient and deemed a specific drug is necessary, based on sound clinical judgment. With prior authorization, the insurance company holds an employee’s care hostage until it reaches the same conclusion as the doctor. This policy second guesses doctors and values profits before expedient patient care.
Prior authorization policies cost employees and employers. Even if the insurer eventually authorizes the prescription for drugs already listed on a health plan’s formulary, they still need to approve the dispensing of the medication which further delays employees from receiving treatment and returning to work as fast as they otherwise could.
Not only do prior authorization policies indirectly cost employers by lengthening the recovery time for sick or injured workers, it directly impacts doctors, who are largely responsible for requesting authorizations from the insurance company and appealing any denials.
The bureaucracy associated with this process is a waste of time and money. Doctors say they spend more time convincing health plans to cover their patients’ treatments than meeting face-to-face with patients or staff. In most cases, doctors do not collect a premium for winning an approval, so hours spent jumping through insurance company hoops represent a substantial, unreimbursed expense.
In addition to prior authorization, insurers deny employees access to their health benefits through a process called step therapy or “fail first,” which requires patients with a particular condition take a specific, pre-approved medication rather than the drug their doctor first prescribed. Even if the doctor objects to the insurance company’s preferred drug, the employee is required to take it, and the doctor must document that it was ineffective, before the insurer will pay for the doctor’s preferred medication.
Fail first lets insurance companies dictate treatment protocols for illnesses without knowing anything about the patients being treated or their individual clinical histories. For some employees, this trial-and-error approach not only delays treatment, it can introduce complicated drug interactions by forcing patients to take pharmaceuticals that are never exact substitutes for the medication the doctor prescribed.
Fail first does not reduce costs, it just shifts the burden to doctors in the form of administrative costs, and to employees through additional physician consultations and emergency room visits.
Insurance is supposed to be peace of mind you can purchase, yet insurance companies have steadily become a major source of stress and anxiety. Employers spend exorbitant amounts subsidizing insurance premiums so they can ensure their employees’ quick recovery and improved well-being. When insurance companies refuse to cover prescribed treatments until everyone has overcome their hurdles, insurers are effectively blocking the very benefit employers paid for.
As long as employer-provided insurance remains a key component of our health care system, health care reform will significantly impact our workforce. Our policymakers should consider how insurance company practices like prior authorization and fail first force workers to spend more time overcoming bureaucratic hurdles than advancing their careers. Legislators should adopt health care reforms that support our workers, and restrict insurance company tactics that delay treatment and undermine care.
Julio Fuentes is the president and CEO of the Florida State Hispanic Chamber of Commerce, a statewide economic development organization representing the interests of more than 604,000 Hispanic-owned businesses.
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