One in four Texas voters say their health insurance company has refused to cover what their physician ordered for them or their families, a new statewide survey has found.
“Insurers are supposed to finance needed care, not prevent it,” said Texas Medical Association President David C. Fleeger, MD. “These big companies are reporting record profits, and our patients are paying for it with their wallets and their health.”
Almost 26% of voters surveyed answered “yes” when asked if an insurance company “refused to cover a medicine, procedure, test, or scan that a doctor ordered for you or a member of your family.” The poll told respondents to include Affordable Care Act, Medicare, and Medicaid health plans in their definition of “insurance company.”
Of those whose doctors’ orders were denied, 10% said they or their family member “got a lot sicker” or a diagnosis was “extremely delayed,” and 6% said they got “somewhat sicker” or their diagnosis was “somewhat delayed.” Another 30% said they paid for the medicine, procedure, test, or scan themselves; 14% said they appealed the denial and the insurance company changed its decision.
“Physicians already know how much time and energy we spend fighting insurance companies on our patients’ behalf,” Dr. Fleeger said. “We already know how much our patients suffer when care is delayed or denied. These survey results document just how widespread and harmful the problem is.”
In the 2019 session of the Texas Legislature, TMA fought for and won reforms that force insurance companies to be more open about what doctors’ orders they review and how that review process works. The new law also requires that the companies’ reviewers work under the direction of a physician licensed to practice medicine in Texas.
Additional changes TMA continues to seek on the state and national levels include:
- Require health plans to eliminate prior authorization requirements for services, medical equipment, and medications that are routinely approved;
- Require health plans to determine patient eligibility and make all other coverage decisions as part of the prior authorization process so that authorization binds health plans to cover and pay for that service or medication; and
- Require plans to streamline or automate the prior authorization process to reduce on-hold and waiting times.
About the survey
TMA commissioned questions related to insurance company practices to be included in a statewide voter survey conducted Jan. 12-14, 2020, by WPA Intelligence. The telephone survey included 800 registered voters in Texas. It was conducted via mobile phone and landlines. The margin of error for full-sample results is plus/minus 3.5%.
Full text of questions, answers, and responses for the two questions referenced above:
In the past year, has an insurance company refused to cover a medicine, procedure, test, or scan that a doctor ordered for you or a member of your family? (By “insurance company,” I also mean Obamacare, Medicare, or Medicaid health plans.)
- Yes – 24%
- No – 69%
- I don’t have insurance – 2%
- Don’t know/refused – 5%
If YES, what happened because of the most recent denial?
- I appealed, and the insurance company changed its decision – 14%
- I paid for it myself – 30%
- I never got the medicine, procedure, test, or scan, but nothing bad happened as a result – 24%
- I or my family member got somewhat sicker, or a diagnosis of an illness was somewhat delayed – 6%
- I or my family member got a lot sicker, or diagnosis of an illness was extremely delayed – 10%
- Don’t know/refused – 17%