Tag Archives: Health Insurance Company

Are Insurance Third-Party Reviewers Denying Patients Access to Necessary Treatments?

Four years ago, a 22-year-old man underwent multiple exploratory surgeries and biopsies to treat his painful symptoms and was diagnosed with SVP Vasculitis, which is an auto-immune disease that causes inflammation of the blood vessels. This disease can be fatal. Luckily, the young man was told by his rheumatologist that Cytoxan, a chemotherapy drug proven to treat vasculitis since 1970. A few days later, the patient’s health insurance company forwarded his claim to the Medical Review Institute of America, which is one of many paid third-party reviewers, to help assess the cost and determine whether the insurance company would cover this treatment. The third-party reviewer advised the insurance company to deny the patient’s request for life-saving, medically necessary treatment. This denial is an alarming trend in the health care industry. After persistently asking for the specific denial letters regarding the patient’s case, he became confused at what he read. The…
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