Doctors Surveyed Say Insurance Denials Hurt Their Patients

Six out of 10 doctors report that health insurance plans refuse at least once a month to cover the cost of drugs they prescribe for patients. And many doctors believe that denial of coverage for medication, tests, hospitalization or referral to specialists has had negative consequences for their patients.

These findings are included in a survey of 1,053 physicians conducted last year by the Kaiser Family Foundation and the Harvard School of Public Health. The survey is included in a compilation of statistics about U.S. health care just released by the consulting firm Deloitte & Touche with VHA Inc., a network of local health-care organizations and physicians.

Twenty-six percent of the doctors--and 30% of nurses who were asked the same question--said that in the past two years they had “often” or “sometimes” exaggerated the severity of a patient’s condition to get medically necessary care for the patient. “This level of conflict and administrative haggling can’t be good for our health-care system or for patients who are often caught in the middle,” commented Drew Altman, president of the Kaiser Family Foundation, which is based in Menlo Park, Calif.

Giving Patients the Benefit of the Doubt

Doctors were asked how often they had exaggerated the severity of a patient’s condition to get the patient medically necessary care.

* Never: 51%

* Rarely: 22%

* Sometimes: 21%

* Often: 5%

* No answer: 1%

Source: Kaiser Family Foundation; Harvard School of Public Health, Survey of Physicians and Nurses, 1999