Rheumatologists Called to Action Against Growing Health Insurance Denials
NORWALK, Conn., Feb. 25, 2015 /PRNewswire/ -- UBM Medica US announces that Rheumatology Network, a leading online community for rheumatologists, features a commentary urging rheumatologists to mobilize, with the help of their patients, against health insurance company practices that delay treatment and can endanger health of people with common diseases like arthritis.
In the article "Rheumatologists! Unite Against the Formulary Police!", Christopher Adams MD, a rheumatologist practicing in Alabama, reveals results of an informal survey about the erosive effects on medical care of having to comply with health insurance formularies (drug lists).
Among his findings:
- Obtaining health insurance pre-approvals (or pre-authorizations) currently requires 0.77 full-time administrative employees per rheumatologist. Medical practices can't afford this expense, he says.
- No longer just for high-tech medications that cost tens of thousands of dollars per month, pre-approvals are now spreading to common and well-accepted treatments used in rheumatology for decades.
- Insurance companies save money by delaying decisions about pre-approvals, thereby increasing the risk of damage from the disease. They often tell patients the doctor simply got the paperwork wrong.
- Relying on private policy manuals, health insurance policy benefit managers (PBMs) without medical training may refuse to authorize treatments that are recommended by professional societies as the standard of care. Sometimes they try to require alternative treatments that are ineffective or may even be dangerous.
Dr. Adams urges his fellow rheumatologists to give patients a letter describing this situation, and to enlist their help in writing to legislators, appealing for laws to regulate these practices. He supplies draft letters that readers may reprint or modify, and suggests three basic principles for an ethical policy about health insurance pre-authorizations.
Rheumatologists treat rheumatic diseases that affect the joints, causing inflammation and often chronic pain. These disorders include rheumatoid arthritis, osteoarthritis, lupus, and juvenile arthritis. According to the American College of Rheumatology , about one of four Americans (more than 53 million) have some form of arthritis. The prevalence is expected to increase rapidly in coming decades as the "Baby Boomer" population ages.
About UBM Medica US
Addressing today's healthcare information needs, UBM Medica US, delivers strategic, integrated communications solutions and comprehensive reach -- online, in print, via custom programs and live events. Improving the effectiveness of healthcare through information and education, UBM Medica US provides unbiased clinical, practical, and business information for physicians, providers and payers resulting in improved quality of care for patients around the world. Through journals, magazines, online communities, live and digital events, and other valuable resources, UBM Medica US also delivers comprehensive communication solutions for the pharmaceutical and related industries. Online communities include CancerNetwork.com, ConsultantLive.com, DiagnosticImaging.com, RheumatologyNetwork.com, OBGYN.net, PhysiciansPractice.com, PsychiatricTimes.com and SearchMedica.com. UBM Medica US is part of UBM Connect which, through a range of aligned interactive environments, both physical and digital – increases business effectiveness for both customers and audiences through meaningful experiences, knowledge and connections. Headquartered in New York, UBM Connect brings together UBM's healthcare business, UBM Medica US; UBM Canon's advanced design and manufacturing event, online and print brands; UBM Connect New York's catering, cruise shipping, customer management, and fine, specialty and custom chemical communities; and UBM Mexico's concrete show. For more information, visit www.UBMMedicaUS.com.
About UBM plc
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