New Texas patient advocacy group fighting unfair health insurance claim denials

HOUSTON - The recent murder of the UnitedHealthcare CEO has ignited a nationwide discussion on the issue of health insurance claim denials.

A Kaiser Family Foundation study found 18% of adults say they've had a claim denial in the last year.

A new patient coalition has formed in Texas to fight for patients.  

The Texas Coalition for Patients is a coalition of patients, physicians and providers, advocating to bring greater accountability to health insurance.

Houston woman shares battles with health insurance

The backstory:

A Houston woman says she joined because health insurance denials are an issue she's had to deal with her entire life.

"I was born with a heart defect. My parents learned insurance was going to be involved from the get-go. I was going to have surgeries, long hospital stays," explained Megan Koehler.  

Koehler says she and her family have had to battle health insurance denials throughout her life.  

"The biggest one was I was put on the heart transplant list when I was 14. And insurance originally wanted us to go out of state.  We live in Texas, we have Texas Children’s Hospital here," said Koehler.

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"It's wild to think about, because when you’re on a heart transplant list, you don’t know when you’re getting the call.  So we could have been there for days, it could have been years," she added.

She says her family was finally able to get the heart transplant covered in Texas.  But she says she's faced more fights for insurance authorizations and claims as an adult, first with Crohn's disease.

"That has led to its own slew of insurance issues with getting medications approved, and then I had Hodgkins Lymphoma," Koehler told us.

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"And getting chemo approved apparently was not the easiest thing either," she explained.

Megan says she did receive the chemo and other care that she needed, but always after lots of back and forth with her insurance providers.

That’s why she joined the new Texas Coalition for Patients.  

Big picture view:

The organization, made up of patients with similar insurance battles, says that it aims to do the following:

• Provide transparency on prior authorization and the denial of medical care
• Address the use of third party entities to deny care
• Ensure health plans using pharmacy benefit managers, which set drug prices, have a fiduciary duty to the patient
• Stop health plans from using AI to determine what’s medically necessary

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"It breaks my heart there are people that don’t know what they can do to fight this. Because this is terrifying. You do think it's a life or death situation, and for a lot of people it is," said Koehler.

In addition to patients, the Texas Coalition for Patients says its members also include the Texas Medical Association, the Texas Hospital Association, and the Livestrong Foundation.

One bill the coalition says it's already working to pass is Texas Senate Bill 815, which would prohibit health insurance companies from using artificial intelligence to deny claims.

What you can do:

You can learn more at Texas Coalition for Patients.