I was surprised when the dentist I had visited for the past three years informed me that my insurance company no longer covered them. It was nice that they told me ahead of my appointment. The last dentist I used stiffed me for a full cleaning, which is covered under my plan, when they neglected to tell me that I was no longer covered. I appealed, and was denied. I told the dentist I’d pay half, and I found a new dentist. This has me empathizing with everyone in the bleeding disorder community, who need a lot of doctors, and the tough times we face ahead.
In a good article in The Week, health insurance companies appear to be denying a growing number of patients. Some facts:
• Health insurers process about 5 billion claims annually for reimbursement or pre-auth.
• Of these 850 million are denied.
• Data disagrees on whether these rates are rising or not
• Fewer than 1% of denied claims are appealed
• A nationwide survey last year found that 73% of health care providers claim that denials are becoming more frequent.
Claims are typically fielded by insurer-employed nurses, who ensure that claims are medically necessary. But there is evidence—no surprise—that denials are more based on saving the insurer money. A patient can appeal, but as noted, most don’t. It’s a hassle, time-consuming and often ends in another denial. I’ve seen on Facebook the frustration our community members endure trying to get the correct factor brand, dosage and amount.
The good news is that if you do appeal, about 75% are approved. It’s like fighting a traffic ticket: most likely law enforcement banks on you not going to court and fighting it. Most insurance companies may not expect you to devote the time and resources to fight a denial.
The good news is that we can fight denials. Ten states passed legislation in 2024 to reduce requirements for pre-auth, for example. But there are 50 states and 20,000 or more people with bleeding disorders. Despite the proactiveness of our national and state bleeding disorder organizations, it seems that insurance will always be our number one concern.
Be sure to always check your health insurance plan annually, as changes can and will be made for coverage. Work with your medical team to reduce paperwork and red tape. Register with your local bleeding disorder organization to stay up to date with what’s happening in your state. Speak with your specialty pharmacy—they want you covered, for sure. Charge your cell phone and be prepared for long holds… but hopefully a positive resolution.
