What to Do When Your Health Insurance Won’t Cover a Treatment

National News
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Recently Kevin Price, Host of the nationally syndicated Price of Business Show, interviewed Dr. David Wilcox.

Health Transparency: The Real Truth with Dr. David Wilcox  

On the recent Price of Business show, Dr. David Wilcox covered the pharmaceutical industry specific to the consumer. He was recently consulted for a cancer patient who was prescribed an oral chemotherapy drug which this person could take at home with minimal disruption. However, it became clear that the insurance company didn’t want to cover this costly treatment. While not flatly denying the medication to the consumer they put them through a series of inconvenient steps. One of which included telling the consumer they would pay for it if they drove two hours to a cancer hospital to take the drug. Someone with stage 4 cancer who isn’t feeling good does not want to spend four hours driving to a hospital for a pill that they could take at home which defeats the purpose of taking an oral chemotherapy drug. To top it off this whole situation was costing the consumer time, which allowed the cancer to continue to spread through their body.
Through this consult, he discovered something that average Americans don’t know but should. He was talking with the person at his doctor’s office as he was recently denied a medication that his doctor had prescribed for him by the pharmacy benefit manager. His doctor had to fill out a preauthorization form which the pharmacy benefit (someone with little to no medical training) denied. When he told this person about the situation above they told him to have the oncologist call and ask for a peer to peer review, meaning two doctor’s discussing the case. The insurance company has to abide by the decision the doctors make. While this probably wouldn’t have helped his situation much. (He was able to go to GoodRx and obtain his drug) anyone dealing with cancer and getting the run around from the pharmacy benefit manager/insurance company needs to know about this peer to peer review.

According to a statement, “Healthcare is complex and that is not an accident. It is complex by the healthcare entities vying for your healthcare dollars. Covid has exacerbated the American Healthcare System, which was fragile, to begin with. Many clinicians are leaving healthcare due to burnout. How does the average layperson navigate the complexities of the American Healthcare System where a prescription could cost you $5 at one pharmacy and $500 at another? What does the average layperson do when their insurance company rejects their claim? Proactive education of the American Healthcare System prior to accessing it is the key to safely navigating the healthcare system. Until now, little information has been available to provide the layperson with the knowledge they need to be a better partner in their health care. Dr. David Wilcox’s book How to Avoid Being a Victim of the American Healthcare System: A Patient’s Handbook for Survival” is a game-changer and will provide you with the skill set you need to navigate the American Healthcare System.

Website: https://drdavidwilcox.com/ 

Dr. Wilcox is a Doctorate prepared nurse who also holds a Masters in Health Administration and is Board Certified in Nursing Informatics. Dr. Wilcox has 28 years of healthcare experience in which he worked as a bedside nurse, hospital administrator, and in healthcare information technology which has helped him to develop his unique perspective on the American Healthcare System.

Dr. Wilcox is the author of the book “How to Avoid Being a Victim of the American Healthcare System: A Patient’s Handbook for Survival (2021)” available at https://www.amazon.com/dp/0578878364

Dr. Wilcox currently resides in North Carolina with his wife and their three dogs.

Dr Wilcox’s website: Dr. David Wilcox – Healthcare, American Healthcare System (drdavidwilcox.com)



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