Ruling Allows Patients to Sue Over Unexplained Prescription Refusals
According to an article published in American Medical News journal, patients have the right to take the District of Colombia, Department of Health Care Finance to court for failing to explain prescription refusals under Medicaid coverage. Patients claim the district is not telling patients the reason for refusals and doesn’t allow for appeals, which they feel violates their patient rights.
The article noted that there are a number of reasons for prescription refusals, and often times it is related to pharmacy or doctor errors. Bruce J. Terris, A patients’ attorney in a 2010 lawsuit regarding Medicaid coverage claimed that if patients were better informed about the process of prescribing medication and the potential mistakes involved, they could use this knowledge when confronting the district. Terris stated, “The need to tell the patient what is happening is a basic right of people. If the government turns you down for something, you should know the reason for it.”
For the most part, the denial of prescriptions is not initiated by the district, but by an error with the pharmacy’s electronic system. The 2010 lawsuit was dismissed because the patients hadn’t suffered any injury, but the decision was reversed due to the possibility that injury could occur without the necessary prescriptions. The U.S. District Court made the ruling to allow the District of Colombia Dept. of Health Care Finance to be sued in an effort to protect patient rights and prevent injury from a lack of medication.
According to the article, in recent years patients have had the right to take private health insurers to court for denying a claim. Patients feel the same should be true for the Medicaid program when medication is denied and the explanation is unclear.
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