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Everyone blames the greed of health insurance companies for the increasing denials of claims and barriers to care. That’s naive. Follow the money to find the real culprits: lying politicians.
According to the American Medical Association, in 2013, before the Affordable Care Act rules took effect, insurers denied about 1.5% of claims. But under the ACA rules, denials increased tenfold. Now, nearly 15% of claims are denied, reports Premier, an insurance consulting firm. Some insurers deny a third or more of claims, according to research from the Kaiser Family Foundation.
Insurers also require pre-authorizations for a variety of treatments and medications, tying your doctor’s hands and dangerously delaying your treatment.
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Your doctor must call the insurer before starting treatment or ordering medication. Rarely is the person on the other end of the line a specialist in the disease or treatment in question. A gynecologist may override your neurosurgeon’s recommendations, warns the AMA.
Anger at health insurance companies is misplaced. People should blame politicians for the problems they cause. (iStock)
Dr. Debra Patt prescribed a combination of medications to a patient with metastatic breast cancer, but had to wait weeks for prior approval. In the meantime, the AMA reports, she had to make do with standard chemotherapy, but to no avail: her patient died.
“There are representatives from health plans who have never met the patient, never been at the bedside or been a physician, but are now making treatment decisions,” argues Tina Grant, senior vice president of public policy and advocacy at Trinity Health, one System of 92 Catholic Hospitals.
Accordingly House Committee on Energy and Commerce According to testimony, 80% of the prior authorizations 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.
After the ACA went into effect, denials and prior authorization requirements increased. But don’t blame profit maximization. The ACA regulates underwriting profits, and when profits increase, insurers must provide discounts to their customers.
According to an IBISWorld industry study, giants like United Healthcare have become profitable behemoths by purchasing doctor’s offices, hospitals and pharmacy chains rather than by selling health insurance plans.
The real reason your health insurance becomes unreliable is this Politicians support Obamacare knowingly made a promise that could not be kept without the insurer resorting to predatory practices.
Proponents of Obamacare promised that everyone would receive the same fees regardless of their “pre-existing conditions.”
The calculation doesn’t work. Each year, 5% of the population uses over 50% of healthcare. This is a fact of nature, politics aside.
Politicians like President Barack Obama pushed for 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, Thursday, September 6, 2012. (Photo by Christopher Evans/MediaNews Group/Boston Herald via Getty Images)
Telling insurers to cover the 5% at the same price they charge healthy people is like offering monthly groceries at the same price to a skinny model and the winner of Nathan’s Hot Dog Eating Contest. Ridiculous.
Five percent more premium payers and 50 percent more medical needs.
The federal government should have stepped in with additional payments to protect people with pre-existing conditions. Instead, insurers were faced with a mountain of new claims and asked to make it work. They introduced draconian cost-cutting methods.
The winners? Democratic politicians. Free coverage of pre-existing conditions is popular.
The losers? Anyone else who may be concerned that their next treatment will be delayed or their next claim will be rejected.
Unfortunately, the biggest losers are the seriously ill, who suffer disproportionately from managed care’s strict controls, according to a National Bureau of Economic Research paper on Medicaid managed care.
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More than half of states are currently enacting laws to restrict prior authorization.
This is a step in the right direction. But Americans need to reevaluate managed care.
After the ACA went into effect, denials and prior authorization requirements increased. But don’t blame profit maximization. The ACA regulates underwriting profits, and when profits increase, insurers must provide discounts to their customers.
There is virtually no evidence that it improves health.
President Joe Biden’s deputy secretary for health policy boasts that the ACA’s expansion of coverage — primarily in managed care — has reduced “morbidity and mortality.” This is an obvious lie. Americans are sicker and living shorter lives than before the ACA.
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An alternative is to allow low-cost catastrophic insurance that only covers the big bills. Healthy people insured at work would benefit from fewer interactions with an insurer and more out-of-pocket payments instead of a whopping $25,000 plan – the cost of family coverage this year.
Democrats are trying to call catastrophic insurance “junk insurance.” The Biden administration has made purchasing nearly impossible. But Americans are beginning to realize that health insurance plans that deny claims and make you wait dangerously long times for pre-approval are the real “trash.”
