Denied Coverage for Insured Patients Warrants Attention

"We've heard a lot from state and national political leaders recently about the need to reform the U.S. health care system" -- "not least to extend coverage to the 47 million Americans who now lack insurance" -- but "what about those who are fully insured and still struggle for coverage of necessary treatments?" Los Angeles Times columnist David Lazarus writes.

According to Lazarus, health insurer officials who make coverage decisions about medical treatments in some cases lack the experience to make those decisions. He cites the case of Monica Blumenfield, an employee of the Long Beach Unified School District whose health insurer, Blue Shield of California, denied her coverage of physical therapy for work-related nerve damage and for an MRI related to earlier treatment for breast cancer. Blue Shield said that the company medical director reviewed the coverage decisions, but the official, an osteopathic physician, lacked experience in either physical therapy or oncology, Lazarus writes (Lazarus, Los Angeles Times, 1/20).