When patients sign up for health insurance, we’re locked into our health insurance plans for a full year. If we stop paying, they stop covering.
But, the same isn’t true for powerful insurance companies.
In many states, including New York, big insurance companies can make midyear changes to the benefits they promise patients. This “bait and switch” in the middle of the plan year commonly comes in two forms:
• Insurance companies will remove a prescription drug from a formulary.
• Insurance companies move a treatment to a specialty tier with higher out-of-pocket charges for patients.
Either way, insurance companies pocket bigger profits as patients pay more money out-of-pocket to access the treatment prescribed by their doctor.
“Shouldn’t insurance companies be locked into providing the same benefits that they advertised, sold and promised — for the entire year?” asks Terry Wilcox, co-founder and executive director at Patients Rising, a national patient advocacy non-profit that battles denials and other barriers to access.
Lawmakers in New York have an opportunity to close this loophole and hold insurance companies accountable to their promises. A.2969, authored by New York state Assembly member Crystal D. Peoples-Stokes and S.2849, authored by New York State Senator Neil D. Breslin would stop insurance companies from making midyear changes to their prescription drug benefits.
Insurance Bait-and-Switch Hurts Patients
Patient advocates say that unfair insurance practices often jeopardize patients’ health.
“When insurance companies make midyear changes, it can have devastating consequences for a patient’s health,” Wilcox says.
For example, patients living with mental health challenges may spend months or years finding the right treatment and the right dosage that allows them to work or go to school. Medications are rarely interchangeable and changes for non-medical reasons can disrupt a patient’s progress.
“Medication continuity is extremely important for people with mental illnesses who are already at risk of non-adherence for a variety of reasons,” explains Mental Health Association in New York State, Inc., which is supporting the pro-patient reform. “Sudden unexpected shifts in medication costs during an enrollment year, or medications being dropped from a formulary altogether, adds precariously to the risk of non-adherence and can be dangerously counter therapeutic.”
Wilcox says that many patients, especially those living with chronic diseases and conditions, spend weeks reviewing policies to find an insurance policy that covers their treatment.
“It’s unfair to deny patients access to their doctor’s treatment,” Wilcox says, “Insurance companies should be required to provide patients with the coverage that they promise.”
NY Pro-Patient Legislation Passes First Hurdle
Patient advocates have tried for years to fix New York state laws that give extraordinary power and special privileges to big insurance companies. This year, they’re making progress.
“This legislation would help to protect consumers from unforeseen higher deductibles, copayments and coinsurance that would result from health care plans moving prescription drugs to a tier with higher patient cost sharing,” argues The Medical Society of the State of New York, another medical organization backing the reform.
A.2969/S.2849 was reported out of the Senate Insurance Committee and is now headed to the Assembly Insurance Committee.
To voice your support for A.2969/S.2849, patients are urged to contact their local state representatives as well as key state lawmakers:
• Senate Majority Leader Andrea Stewart-Cousins
• Senator Kevin Thomas – Chair Consumer Protection Committee
• Senator Julia Salazar – Chair Women’s Health Committee