Health Watched

This afternoon I got a call from an insurance company rep in Nebraska, seeking help for a patient insured by them whose policy does not include an Rx drug benefit.  The caller explained that  the patient has breast cancer and now has been prescribed Femara but cannot afford to pay for it on her own.  Supposedly “every avenue” in the way of patient assistance programs had been explored, but the patient is not eligible for any of the PAPs.  So the insurance company employee decided that I could resolve this  situation for them!!!

I asked the caller where she’d gotten my name and number, and she indicated that it was from one of the listserves on access to medicines of which I am a subscriber.  I explained about how I  work as an independent consultant with  NGOs, hospitals, medical practices, and also with healthcare professionals and with patients,  by first offering a brief no-charge consultation and then, depending on the circumstances, setting up a contract for  in-depth research and trouble-shooting. Those  acquainted with me and my work know that I freely volunteer quite a lot of my time both in-person and electronically on behalf of patients around the world.

To date,  my services have never been requested by an insurance company. I have of course dealt with  insurance companies  both personally and professionally, and have assisted some individuals  in appealing of denials of coverage by their insurers.  I’m pleased to say that in most of these cases, the appeals were successful.

But the insurance company rep who called me today expressed her dismay that I was not volunteering to help the company, and implied that  I was not fulfilling my ascribed role as an advocate who helps patients. And if I were to have  offered to help this specific patient, the caller seemed unaware of the HIPAA regulations that mean that I am not authorized to be  party to the patient’s personal health information,  needed for effective and personalized advocacy.

My advice to the caller was to recommend the patient  contact her legislators at the state and federal level.  A good dose of Congressional sunshine needs to focus on this insurance company too, the sooner the better. And of course the insurance company could offer it’s own solution…