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Home > This Just In > PDAR Shows Rise in Patients Denied Coverage from Commercial Insurance

2012 Patient Data Analysis Report Now Available


2012 Patient Data Analysis Report Shows Rise in Number of Patients
Denied Coverage from Commercial Insurers

Uninsured now represent the largest number of Patient Advocate Foundation patients (34.4%)

Hampton, VA -- The oldest national non-profit organization providing patients with chronic, debilitating and/or life-threatening diseases with one-on-one case management addressing insurance obstacles, medical debt crisis and other barriers to health care today released its annual Patient Data Analysis Report (PDAR). The report issued by Patient Advocate Foundation (PAF) is a statistical analysis of the 109,147 patients from all 50 states assisted by PAF in 2012 and documents mediation and arbitration services necessary to resolve a variety of issues within the health care system as well as the initial impact of newly implemented health care laws.

PAF assisted patients from across the country and several territories; however 11.3 percent of all patient calls were from the state of Florida, followed by Texas (9.1%). The increase in number of requests for direct mediation was greatest in Ohio (47.1%) and Pennsylvania (27.9%).

In the 2012 report, for the first time the uninsured represented the largest group of patients served by PAF at 34.4%, an increase of more than 25% since 2011. Uninsured issues increased from 17.7% in 2011 to 19.1% in 2012 while debt crisis/cost of living issues decreased, suggesting PAF patients are facing more difficulties accessing care than affording care. The report shows specialty tiers for prescription drugs and drug shortages have impacted ability to access medications.

Still, several trends highlighted in the 2012 PDAR suggest that provisions implemented under the Affordable Care Act (ACA) have begun to help certain patients access necessary healthcare services. In 2012 fewer seniors reported an inability to afford their pharmaceutical co-payments, likely related to the ACA provision that reduced the Medicare Part D "donut hole" with discounted drug pricing. Furthermore, fewer young adults between ages 18 and 26 were uninsured after ACA was implemented. In addition, more patients gained access to Pre-existing Condition Insurance Plans (PCIP) by contacting PAF for information and enrollment assistance.

In 2012, as awareness of the Affordable Care Act has grown, 66 percent more patients sought PAF's assistance navigating the insurance availability landscape. Not surprisingly, those seeking general guidance from PAF about ACA and its implications increased from 10.5% in 2011 to 33.9% in 2012 and the expectation is that the trend will increase as the need to interpret the law increases.

Using information captured and reported by PAF's professional case managers, the 2012 PDAR provides insight into difficulties many patients encounter when accessing healthcare in America, and thus supplies invaluable information to policymakers, stakeholders and healthcare providers on emerging trends and issues crucial to national conversations on ways to improve the healthcare system. PAF has now closed hundreds of thousands of cases since its inception in 1996. PAF's extensive documentation of its case management data through the PDAR makes it one of the nation's preeminent sources of information on how patients (insured, underinsured and uninsured) interact with the healthcare system.

In 2012, the number of patients served by PAF increased nearly 6% over 2011, through three service divisions: direct case management; co-payment assistance; and personalized programs designed to meet financial and access needs of special populations of patients. Of the 309 different health conditions encountered by PAF case managers, the number of cancer patients increased to 81.4 percent, with the remaining patients dealing with a wide array of chronic or debilitating conditions including cardiovascular, autoimmune, nervous system, and pediatric illness among others.

"Drawing on the information captured by PAF and documented in the PDAR, the National Patient Advocate Foundation (NPAF), the sister organization to PAF, has selected 18 key policies to pursue in 2013 that aim to achieve five main goals", stated Nancy Davenport-Ennis, CEO and founder of the Patient Advocate Foundation. "These goals include eliminating barriers to healthcare coverage, ensuring access to essential medications and therapies, easing economic constraints on healthcare providers, raising awareness of patient needs, and improving patient outcomes."

In addition to providing analysis of national healthcare trends, the PDAR highlights PAF's 16-year history in resolving complex health insurance access issues, such as benefit denials and appeals. Originally published in 1997, this data has been increasingly requested by lawmakers, MedPAC, congressional offices, academics and advocacy organizations as a quality assessment across many different dimensions, including age, ethnicity, employment status and clinical conditions.

To access a copy of the report, visit www.patientadvocate.org/pdar