Congratulations for shedding light on step therapy, the health insurance practice of requiring patients to try and fail with older, cheaper drugs before the company will pay for the medications their doctors want for them ("Doctors say insurers step over the line," May 4). Sticking with the "tried and true" therapies of yesteryear is not a prescription for medical progress. Unfortunately, it is more and more the mindset of health insurance companies that dic tates the care patients receive.

Recently, patients faced the possibility of receiving colonosco pies without benefit of an anesthesiologist to care for them dur ing the procedure. An insurer made this determination based on cost considerations -- not for the comfort and safety of patients. Over the last decade, medical in novations have allowed us to treat patients in a more efficacious manner. To ignore these advances is tantamount to denying patients the best care that can be offered.

Luckily for patients, the insurer backed off after an outcry from doctors' groups, but the message was clear: Insurers will resist medical advances and steer patients to older, cheaper therapies simply to save money.

Jill Young, Parsippany

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