Dealing with Dying: How Insurers Can Help Patients Seeking Last-Chance Therapies (Even When the Answer is 'No')

Abstract

External review has not cured the health care dispute resolution system with regard to patients' requests for coverage of last-chance therapies, even if it has done some good in the area of medical necessity determinations. This Article discusses the difficult issues posed by coverage requests for last-chance therapies and proposes that insurers take into consideration the state in which patients seeking last-chance therapies are operating when engaging in decisionmaking in this area. Insurers must recognize that denials of coverage will force patients both to face a classic example of a tragic choice in health care, and to come to terms with the fact that no treatment is available to help them live. Communication about decisionmaking and about the decision itself should be accomplished through a process that treats patients as individuals rather than as covered lives and uses multidisciplinary teams to work through a dialogue about the myriad social, emotional and medical issues raised by requests for coverage of last-chance therapies.

Keywords: Health care, insurance, external review, coverage

JEL Classification: K23, K32