… but sometimes patients win!

How the community feels can force a insurer into taking action it didn’t want to.

Recently, Blue Cross Blue Shield of Illinois reversed its decision on requiring pre-approvals for mental health services (Chicago Tribune article) after doctors and others complained.  Prior approvals, as most folks know who work in managed care, are an easy way for insurers an payers to reduce the demand for treatments.  As one doctor recently told me, “I just stay away from prescribing anything on the non-preferred list” (which, of course, leads to the question about who is liable if the “non-preferred” drug doesn’t work … but that’s a topic for another blog).

The good news about this case in Illinois is that it only goes to show what can be done when the public is organized and motivated enough to make its views known. Of course, the trick is to organize and mobilize!

Send me your examples — I’ll be happy to post those that may serve as examples to others fighting similar battles.

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