Doctors spend years studying medicine and dedicate their lives to caring for patients. These medical professionals understand their patients’ medical needs far more than any insurance company ever could, and yet those companies often interfere with people’s access to treatment. This is sadly not uncommon, and three Washington insurance companies were even recently fined for breaking insurance law multiple times.
Two of the involved insurance companies — Premera Blue Cross and its sister company LifeWise Health Plan of Washington — were both fined for mishandling treatment preauthorizations and appeals from policyholders during 2018 and 2019. The fines totaled $100,000 and $50,000 respectively. The Washington Office of the Insurance Commissioner issued those fines after multiple consumers submitted complaints to the office.
One of those complaints involved a man who was supposed to have back surgery in Dec. 2018. However, despite being given a timely manner to do so, Premera did not authorize the surgery in time. His surgery was then rescheduled for Jan. 2019, at which time his deductible reset, and he was responsible for greater out-of-pocket expenses than if he had gone under the knife the month prior.
This is just one of thousands of examples. The review of the complaints involving Premera found that it purposely did not authorize upwards of 5,000 preauthorization requests in what should have been a timely manner. Both Premera and LifeWise also gave policyholders inaccurate information regarding the appeals process.
Washington patients should not have to play games with their insurance companies just to access the coverage they pay for. Not only is this extremely frustrating, but it also threatens people’s health and well-being. Since these companies have shown that violating insurance law is not necessarily a big deal to them, appealing denied claims or pushing for timely authorizations might be easier when working alongside a knowledgeable attorney.