Houston – The recent murder of the CEO of UnitedHealthcare has lit a national discussion on the issue of health insurance claims denials.

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

A new coalition of patients in Texas has formed to fight patients.

The Texas coalition for patients is a coalition of patients, doctors and suppliers, advocating to bring greater responsibility to health insurance.

Houston Woman shares battles with health insurance

The background history:

A Houston woman says she joined because health insurance denials are a problem that she has had to deal with her entire life.

“I was born with a heart defect. My parents learned that insurance would get involved from the first moment. I was going to have surgeries, long stays in the hospital,” Megan Koehler explained.

Koehler says that she and her family have had to fight against health insurance denials throughout her life.

“The greatest was that they put me in the list of heart transplants when I was 14 years old. And the insurance originally wanted us to leave the state. We live in Texas, we have the Texas Children’s Hospital here,” Koehler said.

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“It’s wild of thinking about what to think about, because when you are on a list of heart transplants, you don’t know when you receive the call. So we could have been there for days, they could have spent years,” he added.

She says that her family could finally cover the heart transplant in Texas. But she says she has faced more fights for insurance authorizations and claims as an adult, first with Crohn’s disease.

“That has led to its own series of insurance problems to obtain approved medications, and then I had Hodgkins lymphoma,” Koehler told us.

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“And obtaining chemotice apparently was not the easiest,” he explained.

Megan says he received chemotherapy and another attention he needed, but always after many round trips with his insurance suppliers.

That is why he joined the new Texas coalition for patients.

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

• Provide transparency in prior authorization and denial of medical care
• Address the use of third -party entities to deny attention
• Make sure that health plans using pharmacy benefits managers, which establish the prices of medicines, have a fiduciary duty for the patient
• Prevent health plans from using AI to determine what is medically necessary

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“I break my heart, there are people who do not know what they can do to fight against this. Because this is scary. You think it is a life or death situation, and for many people it is,” Koehler said.

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

A bill that the coalition says that it is already working to approve is bill 815 of the Texas Senate, which would prohibit health insurance companies from using artificial intelligence to deny claims.

What you can do:

You can get more information in Texas Coalition for patients.