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Everyone who blames health insurance company greed for the increase in claim denials and roadblocks should be taken care of. That is stupid. Follow the money to find the real culprits: lying politicians.
In 2013, before the Affordable Care Act went into effect, insurers denied about 1.5% of claims, according to the American Medical Association. But under the ACA rules, denials increased tenfold. Now about 15% of claims are denied, reports Premier, an insurance company. Some insurers deny a third or more of claims, according to a study by the Kaiser Family Foundation.
Insurers require pre-authorization for many types of treatments and medications, tying your doctor’s hands and dangerously delaying your care.
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Your doctor should call the insurance company before starting treatment or ordering medication. It is not uncommon for the person on the other end of the phone to be an expert on the disease or treatment in question. It may be an OB-GYN that goes beyond what your neurosurgeon recommends, warns the AMA.
Anger directed at health insurance companies is wrong. People should hold politicians accountable for the problems they have created. (Stock)
Dr. Debra Patt gave a combination of drugs to a patient with metastatic breast cancer but had to wait weeks for pre-approval. Meanwhile, the AMA reports, he had to prepare for regular chemotherapy, to no avail: His patient died.
“You have health system representatives who have never met a patient, never been at the bedside or administered medicine but are now making treatment decisions,” said Tina Grant, senior vice president of public policy and advocacy at Trinity Health, 92nd system. Catholic hospitals.
According to testimony from the House Committee on Energy and Commerce, 80% of prior approvals Cigna denied to Medicare Advantage customers were overturned on appeal, a sign that legitimate care is being withheld. Cigna uses an algorithm called PxDx to deny prior authorizations in bulk.
Denials and pre-authorization requirements increased after the ACA went into effect. But don’t expect to maximize profits. The ACA regulates underwriting profits, and if profits rise, insurance companies must send customers discounts.
Giants like United Healthcare have grown into behemoths that make money by buying physician practices, hospitals and pharmacy chains, not by selling health plans, according to industry research by IBISWorld.
The real reason your health insurance can’t be trusted is that the politicians who supported Obamacare unknowingly made a promise that was impossible to keep without an insurance company that uses predatory practices.
Obamacare advocates promised everyone would be charged the same regardless of their “pre-existing conditions.”
The math doesn’t work. Every year, 5% of the population uses more than 50% of health care. That is a natural fact, politics aside.
Politicians, like President Barack Obama, pushed Obamacare knowing it would be difficult for insurance companies. File: Obama celebrates after accepting his party’s nomination during the Democratic National Convention in Charlotte, North Carolina on Thursday, September 06, 2012. (Photo by Christopher Evans/MediaNews Group/Boston Herald via Getty Images)
Telling insurers to cover 5% of the same price they charge healthy people is like offering monthly groceries to a fashion model and the winner of the Nathan’s Hot Dog Eating Contest for the same price. Which is funny.
An additional five percent pays the premium and 50% additional medical needs.
The federal government should have stepped in with additional payments to cover people with pre-existing conditions. Instead, insurers receive a flood of new claims and are told to make it work. They use Draconian cost-cutting measures.
The winners? Democratic politicians. Covering existing conditions at no extra charge is popular.
The losers? Everyone else has to worry that their next treatment will be delayed or their next claim will be denied.
The biggest losers, sadly, are the sickest who suffer disproportionately from the tight control of care, according to a National Bureau of Economic Research paper on Medicaid managed care.
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More than half of the states are now passing laws to limit prior authorization.
That is a step in the right direction. But Americans need to reevaluate managed care.
Denials and pre-authorization requirements increased after the ACA went into effect. But don’t expect to maximize profits. The ACA regulates underwriting profits, and if profits rise, insurance companies must send customers discounts.
There is no immediate evidence that it improves health.
President Joe Biden’s assistant secretary for health policy boasts that the ACA’s expansion — particularly in managed care — will reduce “illness and death.” That is a blatant lie. Americans are sicker and living shorter lives than before the ACA.
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Another option is to allow for low-cost catastrophic insurance, which only covers large debts. Healthy people who get help at work can benefit from fewer interactions with insurance and more take-home pay instead of a large $25,000 plan — this year’s cost of family coverage.
Democrats are trying to call catastrophic coverage “junk insurance.” The Biden administration has made it almost impossible to buy. But Americans are beginning to realize that health plans that deny claims and make you wait dangerously long for pre-authorization are real “scum.”
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