Issue #3
On our Radar
A New Level of Patient Advocacy: Taking your Insurer to Court
The Story: A new lawsuit from a chronic illness patient may have just exposed that the denials that chronic illness patients receive for life-changing treatments might actually be a ploy by health insurers to save money, regardless of the health impact.
Tell me more.
Christopher McNaughton, a college student, had suffered for years with a severe case of ulcerative colitis.
After trying every recommended treatment, he finally landed at the Mayo Clinic and was given a new, off-label biologic infusion treatment protocol. A protocol that put his disease into remission and changed his quality of life.
His insurer, United Healthcare, initially approved the treatment but then they changed course and denied it. Christopher was hit with an $800k+ bill for his treatment.
Why did United Healthcare deny his claims?
According to court documents, after United realized that they had spent over $1.7 million on the patient in the prior year they started denying his treatment claims.
They hired outside doctors to review the case and misrepresented the results of multiple peer-to-peer conversations to justify the denials. They also allegedly buried reviews from doctors who highlighted the severe medical risk to the patient if the treatments were stopped.
So how did the patient fight back?
Mr. McNaughton took United Healthcare to court, accusing the company of acting in bad faith and unreasonably making treatment decisions based on financial concerns and not what was the best and most effective treatment.
He said "one motivation for his lawsuit was to expose how insurers like United make decisions about what care they will pay for and what they will not." The case remains pending, but United reversed their denial as a result of the lawsuit.
On our Reading List
Long Covid Might Teach Us How to Prevent Alzheimer’s ... researchers are uncovering links between viruses and brain diseases, which could point to a whole new approach to treatment.
Your Next Hospital Bed Might Be at Home ... in a time of strained capacity, the “hospital at home” movement is figuring out how to create an inpatient level of care anywhere.
Yes, Doctors can Fat-Shame. Here’s what to do about it ... it's no wonder why many chronically ill patients are often mis-diagnosed due to their weight.
Long Covid has an ‘Underappreciated’ Role in Labor Shortage ... new research shows chronic illness can actually have a big effect on our national economy.
Six Words to Say When a Loved One is Having a Bad Day ... do you want comfort or solutions?
What Are Your Top Three Books ... we're partial to memoirs and beach reads.
Who We’re Following
@SpoonieSisterShop is our go-to-spot for all things chronic illness apparel. (she even designed our first Warrior Wear products)
This week she launched a brand new online shop, but her socials are great resources for relatable spoonie life content.
