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Everyone blames soaring claims denial rates and barriers to care on the greed of health insurance companies. That’s so naive. Follow the money and find the real culprit: lying politicians.
In 2013, before Affordable Care Act regulations took effect, insurers denied about 1.5% of claims, according to the American Medical Association. But under ACA rules, the number of denials increased tenfold. According to insurance consultancy Premier, nearly 15% of claims are now rejected. Some insurance companies deny a third or more of claims, according to research from the Kaiser Family Foundation.
Insurance companies also require prior authorization for many treatments and medications, which ties your doctor’s hands and dangerously delays your care.
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Your doctor must call your insurance company before starting treatment or ordering medications. The person on the other end of the phone is rarely an expert on the disease or treatment in question. The American Medical Association warns that obstetricians and gynecologists may override the advice of neurosurgeons.
Anger at health insurance companies is misplaced. People should hold politicians accountable for the problems they create. (iStock)
Dr. Debra Patt prescribed a drug combination for a patient with metastatic breast cancer but had to wait weeks for prior approval. Meanwhile, she had to undergo standard chemotherapy, but it had no effect: her patient died, the AMA reported.
“Health plan representatives who have never seen a patient, never been at the bedside or practiced medicine are now making treatment decisions,” countered Tina Grant, senior vice president of public policy and advocacy at Trinity Health, a 92-person system of patients.
According to testimony before the House Energy and Commerce Committee, 80 percent of the preapprovals Cigna denied to Medicare Advantage customers were overturned on appeal, indicating that legitimate care was being denied. Cigna uses an algorithm called PxDx to deny prior authorization in batches.
After the ACA went into effect, denials and prior authorization requirements continued to escalate. But don’t blame profit maximization. The ACA regulates underwriting profits and insurers must provide rebates to customers if profits rise.
According to IBISWorld industry research, giants like UnitedHealthcare grew into money-making behemoths by buying doctor’s offices, hospitals and drugstore chains rather than selling health plans.
The real reason your health insurance has become unreliable is because the politicians who supported Obamacare deliberately made a promise that would have been impossible to keep without predatory practices by insurance companies.
Advocates of Obamacare promise that everyone will be charged the same regardless of “pre-existing conditions.”
Not good at math. Each year, 5% of the population uses more than 50% of all health care services. Politics aside, this is a fact of nature.
Politicians such as President Barack Obama knew when they pushed for Obamacare that it would be difficult for insurance companies. FILE: Obama celebrates after accepting his party’s nomination at the Democratic National Convention on Thursday, September 6, 2012 in Charlotte, North Carolina. Photographed by the agency)
Asking insurance companies to cover 5% at the same price they charge healthy people is like offering monthly groceries to skinny fashion models and Nathan’s hot dog eating contest winners for the same price. Ridiculous.
Premium payers increased by 5% and medical needs increased by 50%.
The federal government should step in and provide additional payments for people with pre-existing conditions. Instead, insurers were hit with a flood of new claims and told to make it work. They adopted a drastic cost-cutting approach.
The winner? Democratic politician. Free coverage for pre-existing conditions is popular.
loser? Everyone else has to worry about their next treatment being delayed or their next claim being denied.
Sadly, the biggest losers are critically ill patients, who suffer disproportionately under the tight controls of managed 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 passing laws limiting prior authorization.
This is a step in the right direction. But Americans need to re-evaluate managed care.
After the ACA went into effect, denials and prior authorization requirements continued to escalate. But don’t blame profit maximization. The ACA regulates underwriting profits and insurers must provide rebates to customers if profits rise.
There is little evidence that it improves health.
President Joe Biden’s assistant secretary for health policy boasts that the Affordable Care Act’s coverage expansion, primarily managed care, has reduced “morbidity and mortality.” This is a blatant lie. Americans are getting sicker and living shorter lives than they did before the Affordable Care Act.
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One alternative would be to allow low-cost catastrophic coverage that would only apply to large bills. Healthy people who get coverage at work will benefit from fewer interactions with insurance companies and more take-home pay than a plan that costs as much as $25,000 — the cost of home insurance this year.
Democrats are trying to call catastrophic insurance “junk insurance.” The Biden administration has made buying nearly impossible. But Americans are starting to realize that health plans that deny claims and make you wait dangerously long times to get preauthorization are the real “junk.”
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