Tired of rejection, Oregonian takes struggle with health insurance to D.C.
Benjamin Lindner to testify before Senate committee about his battle for coverage
PORTLAND, Ore. (April 1, 2008)-Each Christmas, Benjamin Lindner's family sends a holiday card to a handful of employees working in the claims office of his health insurance provider.
Lindner and his wife are on a first-name basis with several representatives in the company's call center. They forged these relationships over many hours spent on the phone appealing to their insurance provider to cover the medical services and prescriptions the couple require.
Lindner, who has two debilitating conditions, psoriasis and psoriatic arthritis, has battled his insurance carrier for prescription drug coverage for several years. He will testify about his struggles Thursday, April 3, before the U.S. Senate Special Committee on Aging in Washington, D.C., at a hearing chaired by Sen. Ron Wyden (D-Ore.).
Titled "Scrambling for Health Insurance Coverage: Health Security for People in Late Middle Age," it will focus on health insurance problems faced by older Americans. The hearing is part of a larger effort by Wyden to bring attention to the health care crisis.
Ben Lindner's story
Lindner, 54, is a small-business owner in the Eastern Oregon city of Redmond. In 1993, he bought a company-sponsored health insurance policy, paying $5,000 in premiums, copayments and other out-of-pocket expenses. Now Lindner pays around $21,600 annually for the same policy. "This means for every hour I work, $5.19 of my earnings goes just to health care costs," he says.
Along with escalating costs, Lindner also has faced difficulties accessing treatment for his psoriasis and psoriatic arthritis, serious, lifelong conditions. His doctor prescribed a biologic drug, because the drug he had been taking began to damage his liver. To get coverage for the biologic, he underwent an extensive appeals battle with his insurance company. After submitting pertinent paperwork, multiple letters of support from his doctor and exhausting the company's appeal process, Lindner's case was brought before a company panel, which finally approved him for the medication. But before Lindner could fill his prescription, the panel's decision was overruled by the insurance company's chief medical officer. Facing possible disability if he could not acquire the medication, Lindner enrolled in a clinical study on the drug in Seattle, Wash.-a six-hour drive from his house in Oregon.
This is not the only time Lindner's insurance company has denied his claim outright. "It's like the company has this boilerplate response. Someone there just pushes a button, and out comes a denial letter. It's too easy for them to say 'no.' You have to fight everything," Lindner says.
A universal struggle
Paying for insurance premiums and copayments can be a struggle for the healthiest of Americans. For patients such with chronic health conditions such as Lindner, access to adequate and affordable health insurance often is nearly impossible. According to a Kaiser Family Foundation study, people with chronic diseases report significant hardship accessing health care due to cost, resorting to such measures as skipping treatments, reducing medicine dosages or forgoing filling a prescription altogether.
According to the National Psoriasis Foundation, psoriasis and psoriatic arthritis are serious chronic diseases that warrant sophisticated medical care and therapies. Many psoriasis treatments carry side effects and treatments are often used in combination. Over time, treatments that work may lose their efficacy. Moreover, patients who abruptly discontinue treatment, may find their symptoms recur, often more severely than prior to treatment. Further complicating health care choices, psoriasis is also associated with other serious, chronic and life-threatening conditions, such as heart disease, obesity, diabetes, Crohn's disease and mental health conditions.
Improving access to care
Working in collaboration with advocates like Lindner, the National Psoriasis Foundation seeks to draw attention to the problems individuals with psoriasis and psoriatic arthritis face when accessing the care and treatment options they need to remain productive members of society. Through public policy initiatives like the Psoriasis and Psoriatic Arthritis Research, Cure, and Care Act (H.R. 1188/S. 1459), the Foundation works with Congress to secure federal funding, public policies and programs to ensure that progress is made in the fight to improve access to care. The Foundation also works with insurance companies to address medical policies that present undue barriers to patients. As a result of this ongoing dialogue, several companies have altered their policies making them less restrictive and better aligned with the standard of care.
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About Psoriasis
Psoriasis is a noncontagious, genetic disease that results when faulty signals in the immune system prompt skin cells to regenerate too quickly, causing red, scaly lesions that can crack and bleed. It often affects the elbows, knees, scalp and torso but can appear anywhere on the body. As many as 7.5 million Americans have psoriasis, according to the National Institutes of Health. Ten percent to 30 percent of people with psoriasis also develop psoriatic arthritis, an inflammatory disease which causes pain, stiffness and swelling in and around the joints. Psoriasis can affect anyone at any age, including children. There is no cure yet for this lifelong disease.
About the National Psoriasis Foundation
The National Psoriasis Foundation is the leading patient-driven, nonprofit organization dedicated to improving the quality of life for millions of Americans with psoriasis and/or psoriatic arthritis, and their families. We focus on education, advocacy and research toward better treatments and a cure. For more information, please call the Psoriasis Foundation, headquartered in Portland, Ore., at 800.723.9166, or visit www.psoriasis.org.
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