Health Equity & Access Weekly Roundup: August 10, 2024

Survey Exposes Pervasive Billing Errors, Aggressive Tactics in US Health Insurance

A new report from The Commonwealth Fund revealed widespread issues with medical billing errors and coverage denials among insured Americans, significantly impacting their financial stability and health outcomes. Nearly half of insured adults received bills for services they believed were covered, and 17% faced coverage denials even for physician-recommended care. This has led to delays in treatment and worsening health conditions, with 80% of those affected reporting increased anxiety. Insurers are increasingly using aggressive tactics, including rapid claim rejections, often without proper scrutiny, leaving patients burdened with unexpected costs. The report highlights a significant gap in patient awareness regarding their rights to appeal denials, with only 43% doing so, despite a high success rate when appeals are made.

Rising Costs Lead Insurers to Drop Weight Loss Drug Coverage, Further Increasing Patient Burden

Blue Cross Blue Shield of Michigan will cease coverage for 3 major weight loss drugs—semaglutide (Wegovy), tirzepatide (Zepbound), and liraglutide (Saxenda)—starting January 2025, affecting nearly 10,000 members. The decision, driven by concerns over drug cost, efficacy, and patient adherence, mirrors similar moves by other insurers. BCBS Michigan implemented stricter prior authorization criteria, requiring lifestyle modifications and participation in a weight management program. The policy shift has sparked debate over the balance between cost and patient care, particularly in the context of broader struggles among insurers to manage the rising costs of anti-obesity drugs.

Bipartisan Letter to President Biden Highlights Promise of MDMA Therapy for PTSD

Bipartisan lawmakers, led by Rep Jack Bergman, have urged President Biden to consider the critical issue of posttraumatic stress disorder (PTSD) and the high suicide rates among veterans, advocating for the approval of MDMA-assisted therapy (MDMA-AT) as a promising treatment. Highlighting the failure of existing treatments and the urgent need for innovation, they emphasized the significant success of MDMA-AT in phase 3 trials, where 71.2% of participants no longer met the criteria for PTSD. The letter emphasized the potential of this therapy to provide effective relief for veterans suffering from PTSD.

Part 2: Addressing Migrant Workers' Vulnerability to HIV

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At the 25th International AIDS Conference, Musarrat Perveen from CARAM Asia discussed the ongoing health care disparities faced by migrant workers in Asia, particularly regarding their vulnerability to HIV and exclusion from national AIDS programs. Perveen highlighted that despite policy changes, migrant workers in countries like Bangladesh, Cambodia, and Sri Lanka remain marginalized, facing significant barriers to equitable HIV/AIDS care, including stigma, financial burdens, lack of health care coverage, and immediate deportation following positive HIV tests. She called for comprehensive policy reforms to protect migrant workers' health rights, eliminate discriminatory practices, and ensure their inclusion in national AIDS strategies, emphasizing the need for collaborative advocacy and research to drive these changes.

Medicare Advantage Customer Service Is Used Most by Higher-Need Patients

A new study examined the characteristics of Medicare Advantage (MA) enrollees who utilize customer service and found that those in poorer general and mental health, with greater medical complexity, limited income, and higher health care utilization, are more likely to use customer service. Additionally, enrollees from racial and ethnic minority groups, those who prefer languages other than English, and those with lower educational attainment also show higher customer service usage. The findings suggest that MA customer service should be tailored to effectively support this high-need, diverse population, as effective customer service can improve patient experiences and address health equity.