Patients say health insurers are holding health care hostage


US Senator Sherrod Brown (D) Ohio sent letters to insurance companies Thursday asking them to "take a more active role as it relates to preventing and treating addiction."

"I say to the insurance companies all the time both in phone conversations and by letter they need to re-look at their policies," he said.

The letters come after 10TV began to investigate doctors' claims that patients were being denied treatment plans for abuse-deterrent drugs.

One of those patients is 44-year-old Christina. She is recovering from four brain tumors. She came to the Dublin Orthopedic and Spine Center to find relief. Her doctors prescribed an abuse-deterrent pain medication. She says her insurance carrier denied her.

"They want to put me on morphine," she says.

Doctors say abuse-deterrent drugs don't provide the euphoria associated with drugs like Oxycontin or Fentanyl because they are long-lasting.

The drugs, however, are also more expensive, which is why doctors say they are being denied.

Heather Gore, the office manager of the clinic, showed 10TV dozens of denial letters that she's saved since 2014.

Letters from companies like ExpressScripts, CareSource, Humana, Aetna, and Molina Healthcare.

"The insurance companies are denying the safer medications due to cost," says Gore. And she says insurance companies use Ohio law to support their denial letters.

The Ohio Administrative Law she's referring to is Ohio Administrative Rule 5160-1-01.

It says "a medically necessary service must be the lowest cost alternative that effectively addresses and treats the medical problem."

Patients like Christina feel like the law and her insurance provider is holding her health hostage.

10TV contacted insurance companies that have sent denial letters.

ExpressScripts says it "is committed to reducing opioid misuse..and recommend that our clients cover a wide range of medications to treat pain which includes less addictive medicines."

CareSource, the state's largest Medicaid health plan manager, says,"it focuses on the most cost-effective alternative medications for members, medications identified as abuse deterrent may still have some potential for abuse."

Doctor Kedar Deshpande, who runs the Dublin clinic says, "People on fixed incomes can't afford those medications, so what are we telling them if you're not wealthy enough you get to take the abusable drugs that are worse for you and lead to psychological and physical dependency?"

He says Ohio's opioid epidemic will never be solved as long as health insurance companies continue to steer patients towards addictive drugs for pain management.

"If people's pain is not well controlled they are going to turn to other medications they are going to turn to heroin," he says.

Meanwhile, people like Christina are frustrated with a health system she feels is pushing her to take drugs she doesn't want.

"Because they don't want to pay for medications that are safer to take they'd rather put me on morphine," she says.

Senator Brown has given the state's largest healthcare providers the end of the month to respond.

If you've been denied abuse deterrent medication, the Ohio Department of Insurance wants to hear from you. Call 1-800-686-1526.