From a cancer patient: “I had to change insurance in the middle of my eight-month treatment plan. Now I’m waiting to see if my oncologist and current chemotherapy drugs are covered. If they aren’t, I don’t know what I’m going to do. The approval and appeal process are overwhelming.”
From an OB-GYN: “I had a first-time mom due on January 3. She begged me to induce before the end of the year because she’d already hit her insurance deductible. Waiting to deliver until the new year meant paying thousands more in out-of-pocket costs. It’s a real challenge balancing patient care with insurance limitations.”
From a retiree: “In September, the cost of my prescriptions went way up. Turns out, I’ve hit something called the ‘donut hole’ for Medicare. Now I’m shopping around to find which pharmacy offers each drug at the lowest price and enrolling in discount programs to help. I’m not sure how long it will be until Part D kicks back in. Is it always this complicated?”
From a physical therapy practice: “One insurance company is rejecting our payment submission codes. We’ve been trying to resolve the issue for months. We finally had to give up because it was taking too much time. Now we have to tell those patients that we no longer accept their insurance and they have a large balance due.”
These are real stories. Millions just like them plague the health payor industry. This overly complex, highly regulated $1.6 trillion business impacts us all—from patients to workplaces, healthcare systems to individual providers.
Everyone needs healthcare at some point.
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