Filing an appeal for denied coverage with your health insurer can be a bureaucratic mess even in simple cases, like coding errors. But for seriously ill patients, particularly those with late stage cancer who want to undergo new and perhaps unorthodox treatments, the hurdles can multiply, sometimes exponentially. As new cancer treatments like immunotherapy and proton beam therapy emerge, patients may face unexpected hurdles to get access to these treatments. That's because insurers, who operate under the premise of paying only for "standard of care," may routinely deny these out-of-the-ordinary treatments, creating miles of red tape in an appeal. For seriously ill patients, the clock is ticking. Plus, they may be too sick to fight for themselves. That may leave it up to family members and other caretakers to understand how the appeals process works. Here's a preliminary roadmap. Going beyond standard treatment Seriously ill patients may have already exhausted standard treatment for … [Read more...] about Seriously ill? Coverage denied? Here’s what you can do
Why insurance companies deny coverage
Residents of towns damaged by wildfires may need to prepare for another repercussion: insurers that decide to cancel policies because of increased risks from more frequent fires. Facing mounting losses, some property insurers are reportedly pulling back from selling policies in California and other western states where wildfire risk is elevated. In California alone, damages had mounted to at least $12 billion by early 2018, while the state's Carr fire likely added another $1.5 billion in insured losses. The tinderbox conditions in California were already dangerous in January when Insurance Commissioner Dave Jones warned of the "growing problem" of fire insurance unavailability within the state. Now an additional 17 fires are burning throughout the state, including the Carr fire, which has forced 3,800 people to evacuate and scorched nearly 1,000 homes. California Gov. Jerry Brown has called such conditions "the new normal," with more than two million of the state's … [Read more...] about California’s fires are creating another problem: Fleeing insurers
The appeal of artificial intelligence across many industries is impossible to deny. But it may come as a surprise to hear that the insurance industry — typically perceived by outsiders to be one of the more decidedly unsexy industries today — outspends 12 other major industries when it comes to investing in AI. According to the Global Trends Study 2017, insurance invests an average of $124 million per company in this alluring technology. That’s $54 million more than the average across all industries surveyed. Global insurance giant QBE, for one, invested earlier this year in a machine learning company called HyperScience — and that’s not even the first AI investment it’s made. Within the insurance sector, the benefits and drawbacks of AI are an ongoing conversation, one that (apparently) merits an entire summit: Later this month Insurance Nexus will host the Insurance AI & Analytics USA Summit to discuss the rising role of machine learning … [Read more...] about Why insurance companies are betting big on AI-powered chatbots
Visit The Boston Globe Share on Twitter Share on Facebook Comment on this Scroll to top of page By Ed Silverman STAT May 29, 2018 For the past two years, Sarah Benoit has been getting around with the help of a walker, waiting for a medicine that’s out of reach.Benoit, a former congressional aide, has ALS, a fatal neurological disease that gradually causes muscle weakness and paralysis. As it progresses, she struggles to maintain a normal life, but holds out hope that a drug called Radicava — the first new treatment in 22 years — will slow her deterioration.Unfortunately, she can’t get the medicine, even though her doctor prescribed it last fall. Advertisement Like an untold number of ALS patients, Benoit faces a conundrum. She can’t afford the $145,000 price of the drug without insurance, but her insurance provider has denied access to the drug, even though it was approved by the Food and Drug Administration last fall for all … [Read more...] about ALS patients losing time and hope as they wait for insurers to cover pricey new drug
Imagine filing a claim with your insurance company for hurricane damage and, months later, not only is your home not fixed, but you get served with a lawsuit by your insurance company.Dozens of South Florida customers of Deerfield Beach-based People’s Trust Insurance are finding themselves in an unlikely and possibly unprecedented position — they’re being sued by their insurer.Since July 1, People’s Trust has filed at least 242 lawsuits against its policyholders in Miami-Dade, Broward and Palm Beach counties, according to court records. Of those, 161 have been filed since Nov. 17, a day after the Sun Sentinel first reported the strategy.The new suits include 113 against the company’s customers in Miami-Dade, 38 in Broward and 10 in Palm Beach County.People’s Trust says the lawsuits are a last resort against customers who refuse to abide by contract terms they agreed to when they signed up with the unique insurer. Instead of allowing the company to … [Read more...] about Why does People’s Trust Insurance keep suing its own policyholders?