Insurers' decisions, however, are getting challenged more often.įrom January to July 2018, 1,151 consumers appealed their insurance denials, up 110 percent from the same period in 2017 and more than 200 percent from the same period in 2016, according to state data. Horizon in a statement Thursday said it relies on medical and scientific research to "ensure that no matter how complex medical conditions or procedures may be, our coverage provides for the most appropriate and safest care, based on the best and most current clinical evidence available." MORE: Blame brand name drugs for rising health costs, Horizon saysĬonsumers are increasingly taking the fight to the state's Independent Health Care Appeals Program, an appeals process that has been available to many New Jersey consumers since 1997 but has rarely been used. MORE: Can Asbury tech firm help new moms steer clear of opioids? "The consumer can sometimes be put in the middle of that and can be forced to make phone calls back and forth, which just adds stress to the consumer’s health care experience, which is really unnecessary," said Theresa Edelstein, a vice president at the New Jersey Hospital Association, a trade group. And it could intensify as new, costly breakthroughs become available.īut as the Harkels show, the process is emotionally draining, forcing them to find time to take off from work, plead their case in front of Horizon's insurance board and lose sleep. They are jumping into a fray between doctors and insurers over what constitutes medically necessary treatment. It's a sign, state officials said, that consumers are more aware of the option and are more aggressively fighting back. And they are finding success. More than half of the insurers' denials in recent years that have gone to appeal have been overturned. The Harkels are among an increasing number of New Jerseyans who are appealing their insurance denials with the state Department of Banking and Insurance. "It's been so many years of such bad news continually, I was pretty shocked," Deanna Harkel said. Watch Video: NJ couple fights Horizon in bid to have a babyĪfter four miscarriages and denials from Horizon Blue Cross Blue Shield of New Jersey to cover fertility treatments, Deanna and Jon Harkel braced themselves for more disappointment.īut when they read through the letter from the doctor who reviewed their appeal of the insurance denial, they were heartened.
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