Skip to Content

Big surprise: NC insurers push back on covering patient care

Several bills in the North Carolina House would limit insurers’ ability to deny claims – and they’re not happy about it.

Like other states, many in North Carolina struggle to access quality healthcare. Several bills are in review by the state’s House Health Committee, many of which seek to improve access for patients by limiting insurers’ ability to restrict care.

Shocker: When pressed to actually cover the care their members need, insurers are balking. According to an article in The Carolina Journal, insurance representatives are arguing the bills would increase health insurance costs for consumers.

But take a look at the proposed bills below and see for yourself. From our vantage point, any pushback is purely profit-motivated.

H.B. 649, the “Ensure Timely/Clinically Sound Utiliz. Review” bill
This bill would give insurers less power to leverage utilization reviews and prior authorization processes to deny or delay patient care. In other words, when your doctor recommends a test or treatment, and you must wait for your insurance company to give you the green light (and they often don’t). These processes are known to delay care and result in worse outcomes.

H.B. 654, the “Pharmacists/Vaccine Admin./Test and Treat” bill and H.B. 450, the “Pharmacist Provided Health Care Services” bill
These bills would require that insurers reimburse pharmacists at the same rate as advanced practice medical professionals for comparable services. Seems fair, right? Well, big surprise, insurers don’t want to pay.

H.B. 680, the “Improved Access to SMI Prescription Drugs
This bill would limit insurers’ ability to trump a physician’s recommended prescription drug for patients with severe mental illness and, ostensibly, force them to use a cheaper option. From their perspective, it “removes a health plan’s ability to conduct reviews to ensure the viability, safety, and affordability of prescription drugs.” Right, because we all trust our insurer more than our doctor when it comes to viability and safety. And as for affordability, yes, some drugs are more expensive than others. That’s why we have insurance, so we can access the treatment that works best for our condition.

One opponent of these bills includes Peter T. Daniel, executive director of the North Carolina Association of Health Plans. “All these bills are health insurance mandates, which increase health insurance premiums and put the largest burden on small businesses and individual consumers,” said Daniel.

Our translation: If you don’t let us control when and where patients receive care, we’re upping our prices. But wait, didn’t insurers make record profits last year? Like, billions-with-a-B in profits? Couldn’t some of that money go toward covering needed services? One would think! But then, profits might not be quite so record-breaking next year, and for insurance companies and the shareholders to whom they answer, that’s simply not acceptable. As for patient access? Good luck!

Original Article:

Subscribe to Un-covered Essentials

Insurer policies limit coverage and disrupt patient care, while producing record profits for corporate shareholders. Stay informed with the Un-covered newsletter.