Leah Kovitch was pulling invasive plants in the meadow near her home one weekend in late April when a tick latched onto her leg.
She didn’t notice the tiny bug until Monday, when her calf muscle began to feel sore. She made an appointment that morning with a telehealth doctor — one recommended by her health insurance plan — who prescribed a 10-day course of doxycycline to prevent Lyme disease and strongly suggested she be seen in person. So, later that day, she went to a walk-in clinic near her home in Brunswick, Maine.
And it’s a good thing she did. Clinic staffers found another tick on her body during the same visit. Not only that, one of the ticks tested positive for Lyme, a bacterial infection that, if untreated, can cause serious conditions affecting the nervous system, heart, and joints. Clinicians prescribed a stronger, single dose of the prescription medication.
“I could have gotten really ill,” Kovitch said.
But Kovitch’s insurer denied coverage for the walk-in visit. Its reason? She hadn’t obtained a referral or preapproval for it. “Your plan doesn’t cover this type of care without it, so we denied this charge,” a document from her insurance company explained.
Health insurers have long argued that prior authorization — when health plans require approval from an insurer before someone receives treatment — reduces waste and fraud, as well as potential harm to patients. An …