Op-ed: Patricia Goldsmith asks, what’s insurance for?

Patricia J. Goldsmith is chief executive officer of CancerCare. She wrote the following op-ed on accountability and transparency in the insurance industry. 

What’s Insurance For? 

As a longtime advocate for cancer patients, I often ask the same question to medical directors while helping individuals navigate insurance industry bureaucracy: “If this was your friend or family member — wouldn’t you want them to have the very best treatment?”

After all these years, I’ve become frustrated with the same sterile response focused on insurance policy design and coverage. Or having my question go completely unanswered. I’ve come to the conclusion that patients are anything but insurers’ top priority.

Something has to change.

When I recently read that insurers in Washington State proposed an average rate increase of 19% for 2019 plans – despite the fact that they sit on an excess of $3.5 billion in reserve funds – I can’t say I was surprised. I also wasn’t surprised to learn about a Seattle doctor forced by insurance-company requirements to let many of his patients fail on older, ineffective medicines before they became eligible for the treatments proven to make them get better.

What I am surprised at, is that it’s taken so long to shine a light on the shady calculus behind insurers’ process for determining what is “best” for patients – and that meanwhile, Olympia lobbyists have had the gall to introduce legislation that would make it harder for the public to access financial information from insurers. All of this, without any substantive public outcry.

If you or a family member has been through the grueling experience of trying to get a treatment approved by your insurance company, you’ve most likely been told treatment wasn’t “medically necessary” or “in-network.” Unfortunately, these cases are all too common. They are a reminder that without any savvy support system behind you to tackle the insurance industry’s red tape – patients are often left in worse shape than they started in.

If that’s you, then you’re not alone.

Those of us who advocate for patients know how damaging this system is and can be. Action is long overdue for patients to get the insurance benefits they pay for and deserve. The time has come for real public outrage that demands accountability and transparency on how insurers run their business. We must all come together and ask: #whatsinsurancefor?

Starting this month, the Office of the Insurance Commissioner will review Washington insurers’ proposed premium rate changes for 2019. Let’s demand insurers provide their rationale behind these premiums. Let’s demand they address sitting on billions in reserves while increasing insurance rates.  Let’s demand that all insurers make coverage determinations based on the best interests of the patient, not their profit margin. Let’s demand that insurers have clinical experts reviewing physician and patient requests to provide fair and unbiased opinions.

Let’s demand change by sharing your story. Tell it to the state’s insurance commissioner’s office or attorneys general. Call, email, or visit your state legislator in Olympia – or their district office. Anyone who will listen.

And let’s make sure that patients get the care we would all want for our mothers, sons and best friends.