EP200: Shenanigans to Deny Coverage for Evidence-Based Treatments, With Stacey Worthy, Partner at DCBA Law & Policy
October 04, 2018
200
35:37

EP200: Shenanigans to Deny Coverage for Evidence-Based Treatments, With Stacey Worthy, Partner at DCBA Law & Policy

Stacey L. Worthy, Esq, is a partner at DCBA Law & Policy, where she counsels members of the health care industry, including nonprofit patient advocacy organizations, treatment programs and providers, recovery residences, urine drug testing laboratories, and pharmaceutical companies. As counsel to the nonprofit Aimed Alliance, Stacey provides legal insights that drive the organization’s education, advocacy, and policy initiatives.

Based on her extensive research and analysis of federal and state laws, regulations, and legislation affecting access to quality health care, Stacey authors scholarly articles for publication, drafts model legislation, develops policy positions, and assists with coalition-building efforts of allied organizations focused on advancing common goals. She is also a featured speaker at national conferences and contributes commentary that addresses important issues impacting patients with serious chronic diseases and rare conditions.

She earned her Juris Doctorate degree from the George Mason University School of Law and graduated magna cum laude from Boston’s Suffolk University.


02:11 Stacey’s role with Patient Power and what Patient Power does.
02:55 A recent Patient Power case study.
05:57 The problematic situation with investigational treatments and the lag between guidelines and science.
06:46 The insurance catch-22 happening for patients.
08:48 The methods of bureaucracy insurance companies will use to avoid paying for expensive treatments.
13:08 The ideal policy in Stacey’s opinion.
15:35 The patient perspective.
17:50 A preview on a study about physician burnout.
19:48 “The big problem there is that health plans are typically siloed.”
20:47 “It’s one pocketbook.”
21:36 Stacey’s advice to employers.
21:49 “You really do need to look at both sides of the plan.”
22:03 Co-payment accumulators.
27:48 The federal stabilization efforts with the Affordable Care Act.
31:14 The problematic switches health systems are doing with drugs that are deemed interchangeable.
34:06 “Those health decisions ... should remain with the practitioner.”

healthcare,insurance,payers,dcba law & policy,deny coverage,evidence-based treatments,
|
|

Episode Support Provided By

Special Thanks to Our 2026 Sustaining Monthly Donors

Marilyn Bartlett, Kimberly Carleson, Dylan Yahn, Benjamin Light, Matt McQuideAnn Kempski, Spencer Allen, Scott Tromanhauser, 
Steven Elkins, Matthew Bunte, and Lori Smith.

Recent Episodes

EP519: The Current State of Primary Care—Inevitable or Fixable? With Lisa Rosenbaum, MD
Relentless Health ValueJuly 08, 2026
519
40:0036.61 MB

EP519: The Current State of Primary Care—Inevitable or Fixable? With Lisa Rosenbaum, MD

Listen on Your Favorite App Hello, all you Relentless Tribe members. Today, let's start here. Right now, we are watching a very visible exodus of brilliant, consummate primary care (and other, honestly) physicians leaving traditional practice for concierge medicine or otherwise. For a full transcrip...

EP518: How Do You Explain the Difference Between an ASO Vendor and a TPA? With Claire Brockbank
Relentless Health ValueJuly 01, 2026
518
14:2513.2 MB

EP518: How Do You Explain the Difference Between an ASO Vendor and a TPA? With Claire Brockbank

Listen on Your Favorite App Dr. Alex Sommers: Hi. I'm Alex Sommers. I'm president of Astia Health, an advanced direct primary care organization, an emergency medicine and lifestyle medicine physician, as well as a licensed employer health plan advisor from Wisconsin. I'm curious how you explain the ...

EP517: The Business of Prior Auths: The 401-Level Financial Motive Behind Prior Auths
Relentless Health ValueJune 24, 2026
517
27:2325.07 MB

EP517: The Business of Prior Auths: The 401-Level Financial Motive Behind Prior Auths

Listen on Your Favorite App Hello, Relentless Health Value Tribe. Welcome to it. So, yeah … last week, I had a great conversation with Ophelia Johnson ( EP516 ) that is a companion show, I would say, to this one. So, listen to that one first. Listen to this one first. You do you. For a full transcri...

EP516: GLP-1s and Cash Pay From the Pharma Manufacturer Point of View, With Ophelia Johnson
Relentless Health ValueJune 17, 202644:0540.35 MB

EP516: GLP-1s and Cash Pay From the Pharma Manufacturer Point of View, With Ophelia Johnson

Listen on Your Favorite App Hello, all you Relentless Tribe members. Welcome to it. Today we have a show that will bend your mind in new directions. And yes, I have a head cold at a very weird time of year. I have trouble apparently doing things like normal people. Anyway, we talk a lot on this podc...

EP515: SNF (Skilled Nursing Facility) Fraud—Or Is It Fraud? With Michelle Cera, PhD
Relentless Health ValueJune 10, 202643:0739.47 MB

EP515: SNF (Skilled Nursing Facility) Fraud—Or Is It Fraud? With Michelle Cera, PhD

Listen on Your Favorite App Hello, all you Relentless Tribe members. Lately, I have been just obsessed with what's hiding in plain sight: the root cause glitches in how American healthcare is built. Not the symptoms now. Not the noise. The actual ground zero. I mean, what we call healthcare in this ...

EP514: Successfully Suing a Health System for Their Anticompetitive Contracts and Also Collecting Damages for Plan Sponsors and Members, With Matt Cantor
Relentless Health ValueJune 03, 2026
514
43:4340.02 MB

EP514: Successfully Suing a Health System for Their Anticompetitive Contracts and Also Collecting Damages for Plan Sponsors and Members, With Matt Cantor

Listen on Your Favorite App Hello, all you Relentless Tribe members. This is the third episode in our legal goings-on trifecta, starting with Doug Aldeen in episode 512 covering what amounts to the main reasons plan sponsors wind up suing their brokers or employee benefit consultants. For a full tra...

EP513: Revisiting Cunning Anticompetitive Hospital Contracts, With Brennan Bilberry

EP513: Revisiting Cunning Anticompetitive Hospital Contracts, With Brennan Bilberry

Listen on Your Favorite App If you are a large employer, union funds broker, fiduciary, or anyone responsible for a health plan that spends half of its dollars on hospital care (which most do), or if you have anything to do with policy or enforcement of policy, yeah … listen this week and next week....

Listen and Follow

Sponsored by Aventria Health Group
©2026 BD Bridges LLC. All Rights Reserved.