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Insurers Should Honor Health Plan Contracts

Pittsburgh Post-Gazette: Insurers should honor health plan contract

Pennsylvanians are increasingly finding the health care policies they sign up for are falling short. Health plans are changing the cost and availability of care that is marketed and sold during open enrollment — even after consumers are locked into their annual plans. 

For commercially insured Pennsylvanians, especially those managing chronic conditions, the effects of these midyear changes can be devastating. Reducing or eliminating coverage for an effective treatment can cause patients to lose control of their condition and increase ER visits and avoidable hospitalizations.

Thankfully, legislation in Pennsylvania would help guarantee consumers get the health coverage they purchased.

House Bill 2113 would prohibit commercial health insurers from making coverage changes during the policy year that deny or increase the cost of a treatment, service or prescription a patient is already receiving.

While HB 2113 restricts coverage reductions, it preserves the flexibility for insurers to utilize generics and remove treatments and services deemed unsafe by the FDA.

If patients are locked into their policy for the year, the benefits they rely on should be, too. 

Any alteration to a treatment plan could lead to unforeseen medical complications. Each year, nonadherence to treatment regimens contributes direct costs of $100 billion to the U.S. health care system. The only person altering a patient’s treatment should be a physician; it’s only commonsense that insurers and pharmacy benefit managers shouldn’t be, especially during the policy year.

People with chronic conditions like liver disease, for example, who suffer from serious complications, including cirrhosis, abdominal pain and chronic fatigue, can experience health crises when the insurance coverage they rely on disappears.

When insurers make treatment changes, it’s not about their health — it’s about saving money. But these treatment changes often increase overall health care costs for patients and the state. 

People should not worry about losing their health or independence because their carefully selected health plans abruptly change. But unless House Bill 2113 passes, Pennsylvanians will continue to worry if they’ll get the coverage they signed up for.

Our legislators have an opportunity to address a serious issue that’s impacting our neighbors right now. They should do the right thing and support this legislation and require that health insurance providers honor their contracts with Pennsylvanians. 

SUZANNA MASARTIS

Executive Director

Community Liver Alliance

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