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Are Shrinking Insurance Networks Putting Patients at Risk?

As health insurance companies seek to reign in costs, many patients are being forced to seek costly out-of-network care. In a case recently detailed in the Los Angeles Times, a California man was forced to bear the cost of his life-saving treatment after his insurance company gave up on him.

As the Times reports, Jalal Afshar has a rare condition called Castleman’s disease. When his conditioned worsened, Afshar sought treatment from a specialist in Arkansas. His insurance company, Kaiser Permanente, granted the request to consult with the doctor but declined to pay for the cost of treatment. Instead, it advised Afshar to enter hospice care.

Afshar ultimately decided to proceed with the costly treatment, which involved stem-cell transplants, chemotherapy and other treatments. While he credits it with saving his life, Afshar now owes $2 million in medical bills and has filed a lawsuit against Kaiser for breach of contract and unfair business practices.

Unfortunately, Afshar is not an isolated case. Since 2008, 280 complaints have been lodged against Kaiser by patients who had difficulties reaching a specialist, according to the California Department of Managed Health Care. Other insurance companies are also decreasing their physician and hospital networks, often to the detriment of the sickest, most expensive patients.