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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


Denial of Treatment or Medications?

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Question: As it stands now, health insurance companies determine approval or denial of procedures and medications patients receive. I have heard that denials can be controversial and not necessarily based in the best care for the patient but rather the insurance company’s bottom-line. Is this a real assessment and does the ACA address this concern in any meaningful way legislatively?

Answer: In my experience, most questions of whether or not a medical treatment or prescription drug is covered arises out of the “small print” portion of the policy that can be unintelligible to humans including the providers and insurers themselves. The ACA law goes a long way towards solving this problem by requiring “clear language” and standard benefit descriptions.

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