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Everyone blames the greed of the health insurance company to high claim denials and roadblocks to care. This is naive. Follow the money to find the real culprits: the lying politicians.
In 2013, before the Affordable Care Act regulations began, insurance companies denied approximately 1.5% of claims, according to the American Medical Association. But under ACA rules, denials increased tenfold. Now nearly 15% of claims are denied, reports insurance consulting firm Premier. Some insurance companies deny a third or more of claims, according to Kaiser Family Foundation research.
Insurance companies also require prior authorization for a wide range of treatments and medications, tying your doctor's hands and seriously delaying your care.
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Your doctor should contact your insurance company before starting treatment or ordering medication. The person on the other end of the phone is rarely a specialist in the disease or treatment in question. It's possible for an OB-GYN to go beyond what a neurosurgeon recommends, the AMA warns.
The anger against health insurance companies is misplaced. People should hold politicians responsible for the problems they have caused. (Istock)
Dr. Debra Butt prescribed a combination drug to a patient with metastatic breast cancer, but she had to wait weeks for advance authorization. Meanwhile, according to the AMA, she had to settle for standard chemotherapy, but to no avail: her patient died.
“You have health plan representatives who have never met the patient, never been at the bedside or practiced medicine but are now making treatment decisions,” disagrees Tina Grant, senior vice president of public policy and advocacy at Trinity Health, a 92-physician system. . Catholic hospitals.
according to House Committee on Energy and Commerce According to his testimony, 80% of the prior approvals Cigna denied to Medicare Advantage customers were overturned on appeal, a sign of withholding legitimate care. Cigna uses an algorithm called PxDx to deny prior authorizations en masse.
Denials and prior authorization requirements escalated after the ACA took effect. But don't blame profit maximization. The ACA regulates underwriting profits, and if profits rise, insurers must send rebates to customers.
Giants like United Healthcare have evolved into giant corporations that make money by buying up doctor practices, hospitals and pharmacy chains, not by selling health plans, according to industry research IBISWorld.
The real reason your health insurance is unreliable is this Politicians support Obamacare He deliberately made a promise that was impossible to keep without the insurance companies resorting to predatory practices.
Obamacare advocates promised that 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. This is a fact of nature, regardless of politics.
Politicians, such as President Barack Obama, have defended Obamacare knowing that 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 6, 2012. (Photo by Christopher Evans/Media News Group/Boston Herald via Getty Images)
Requiring insurance companies to cover the 5% at the same price they charge healthy people is like offering a skinny model and the winner of the Nathan's Hot Dog Eating Contest a monthly groceries at the same price. silly.
A 5% increase in premium payers and a 50% increase in medical needs.
The federal government should have stepped in with additional payments to cover people with pre-existing conditions. Instead, insurers were exposed to a mountain of new claims and told to make it work. They have adopted aggressive cost-cutting methods.
Winners? Democratic politicians. Coverage for pre-existing conditions at no additional charge is common.
Losers? Everyone else has to worry about having their next treatment delayed or having their next claim denied.
Unfortunately, the biggest losers are seriously ill patients who suffer disproportionately from the strict controls of managed care, according to a National Bureau of Economic Research paper on Medicare managed care.
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More than half of the states now pass laws to limit prior licensing.
This is a step in the right direction. But Americans need to reevaluate managed care.
Denials and prior authorization requirements escalated after the ACA took effect. But don't blame profit maximization. The ACA regulates underwriting profits, and if profits rise, insurers must send rebates to customers.
There is no evidence that it improves health.
President Joe Biden's assistant secretary for health policy boasts that the Affordable Care Act's expansion of coverage — mostly in managed care — has reduced “morbidity and mortality.” This is a blatant lie. Americans are sicker and living shorter lives than they were before the Affordable Care Act.
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One alternative is to allow low-cost catastrophic insurance, which applies only to large bills. Healthy people who get coverage at work will benefit from fewer interactions with the insurance company and more take-home pay rather than a massive $25,000 plan — the cost of family coverage this year.
Democrats are trying to describe catastrophic coverage as “junk insurance.” The Biden administration has made purchasing nearly impossible. But Americans are starting to realize that health plans that deny claims and make you wait a dangerous period of time to get prior authorization are the real “junk.”
