Access to care: One nurse's triumph

Judy Tsatsos is a registered nurse in Minnesota who has tried numerous treatments—from topical ointments to systemic to biologics—to ease the painful symptoms of her plaque psoriasis. Living with psoriasis for over 40 years, in addition to being a medical professional, makes Judy an expert on what works for her. So when she found a biologic medication that relieved her symptoms and gave her a "life-line to a more normal and productive life," Judy was ready to stick with it. Imagine her surprise when her health insurance company sent her a letter stating that "this service is not medically necessary as determined by a physician reviewer"!

Judy is not one to take this denial without fighting back. She immediately appealed the decision by Blue Cross Blue Shield of Minnesota and sent copies of her candid and indisputable argument not only to the National Psoriasis Foundation, but to the Attorney General of Minnesota and the American Academy of Dermatology. Judy’s doctor also wrote a letter on her behalf, citing his experience as a Board Certified Dermatologist and his opinion that this medication was the best option for Judy. The Consumer Services Division of the Attorney General’s office contacted Blue Cross Blue Shield requesting that the health plan review and respond to Judy and her doctor’s concerns. The reversal of the decision arrived so quickly that it is possible the appeal was fast-tracked as soon as the words "Attorney General" were noted on the recipient list of Judy’s original letter!

Judy’s persistence in advocating for the best treatment for herself paid off and she can now get the medication she needs. Her case is a stellar example of the fact that insurance companies can and do make mistakes, and health care consumers have the right and responsibility to ensure that they are being treated fairly and accessing the benefits covered under their plan. In addition, sometimes health insurance plans have policies that serve as a barrier for people with psoriasis and psoriatic arthritis to access needed care. The National Psoriasis Foundation has advocated successfully with health plans, such as Aetna and Blue Cross Blue Shield of California, to change policies that are not patient-centered. If you believe your health plan has wrongly denied treatment, or that the policy is burdensome or unfair, let us know! Contact Bethany Wofford, Health Policy Manager at advocacy@psoriasis.org or 503.546.5552.