Protect patients from insurance bait and switch

They can obtain top-notch insurance, diligently stay in-network and study the fine print, but still, no guarantees.

Even when patients do everything right, sometimes it’s still not enough.

They can obtain top-notch insurance, diligently stay innetwork and study their policy’s fine print. Even then, there’s no guarantee their health insurance will cover needed treatment when their doctor recommends it.

The bottom line: Insurance companies can simply change the rules in the middle of the game.

One of the most troubling ways is when insurance companies engage in non-medical switching: Selling one health insurance plan, then — after patients are locked into a contract — stop covering the medications they advertised.

“It’s bait and switch,” says Steve Marmaras, director of advocacy for Global Healthy Living Foundation. “It’s bad enough for patients when plans change formularies at the beginning of a contract year, but when it happens midyear, we think that crosses the line over into unethical behavior.”

Non-medical switching has different forms, all of which hurt patients. For example, an insurance company might remove a life-saving medication from a formulary list in the middle of the year, or move an effective treatment to a more expensive specialty tier. Either way, insurance companies collect bigger profits as patients pay more money out-of-pocket to access the treatment prescribed by their doctor.

For patients that can’t afford to pay, non-medical switching can harm them, too. Medications are rarely, if ever, equivalent; it’s not the same as swapping out one cola for another. Even the difference of a few nano-particles can have profound consequences, especially patients living with mental health challenges.

Patients may spend months or years finding the right treatment in the right dosage that allows them to work or go to school. Even a few days spent adjusting to a new medication can cause patients to suffer, or initiate a downward health spiral.

In some cases, stopping and then restarting a medication can undermine a treatment’s effectiveness. When this occurs, patients are not only directly harmed, but are likely to require additional, more costly health care. Ultimately, non-medical switching drives up the cost of health care with increased hospitalizations, additional emergency room visits, and more expensive treatments.

“When patients lose access to the therapy that stabilizes their condition, they may also lose the ability to manage their disease, facing re-emerging symptoms and new side effects,” explains U.S. Pain Foundation, a nonprofit organization dedicated to serving patients who live with chronic pain.

Is there any way to change all this? Fortunately, Connecticut lawmakers have the chance to level the playing field. House Bill 7123, which has garnered support from both sides of the aisle, aims to bring fairness and equity to Connecticut’s health care laws by stopping non-medical switching.

“Changing a patient’s prescription without prior warning and while they are still locked into their health plan is a dangerous practice,” explains the bill’s co-author Rep. Michelle Cook, D-Torrington.

Patients living with serious illnesses and chronic diseases tell us that House Bill 7123 is a matter of fundamental fairness and medical safety.

Ultimately, the patient voice is making the difference by asking a fundamental question: If we can’t change health plans in the middle of a plan year, how can insurers change coverage benefits anytime they want?