Despite years of public debate about overhauling the nation’s healthcare system, the U.S. government cannot say definitely that Americans who purchase health insurance can reasonably expect to be covered when they need it most. The only official, comprehensive data on insurance company treatment denials were compiled in a 2011 Government Accounting Office (GAO) report, which has yet to be updated.
According to a recent consumer survey commissioned by the Doctor-Patient Rights Project (DPRP), however, the health of as many as 53 million insured Americans may be in jeopardy by insurance companies that refuse to cover treatments for chronic or persistent illnesses. The nationwide survey, which polled Americans with private health insurance or coverage under Medicare or Medicaid, revealed an alarmingly high rate of denial—nearly one in four (24 percent) —among patients treating chronic or persistent illnesses.
WASHINGTON – MARCH 10: Desni Crock (L) of Marietta, Ohio, and her three-year-old daughter Bridget (R) attend a forum to tell their stories about denied coverage by insurance companies March 10, 2010 on Capitol Hill in Washington, DC. Bridget was diagnosed with a rare form of lung cancer in 2008 and she was denied with coverage for a more than $35,000 treatment bill in the first two months from an out-of-network hospital. Her current insurance plan only covers 60% of the high cost test and treatment bills with a $12,000-deducible. (Photo by Alex Wong/Getty Images)
Even worse, DPRP’s data indicated that coverage denials disproportionately impact the most vulnerable patients, who need treatment the most. Up to 70 percent of the denied claims, for example, were for treatment of a chronic or persistent illness or condition described as “serious,” and up to 43 percent of the consumers denied described themselves as already “in poor health.”
In most cases, even patients who eventually won coverage of their treatments had to wait more than a month for the insurance company to make a decision. Nearly a third (29%) reported that their conditioned worsened while they waited.
Aside from delaying effective healthcare, the whole process of battling insurers to authorize treatment coverage creates a paperwork nightmare for doctors. The process of seeking prior authorization from insurers and appealing initial denials also contributes to an estimated $471 billion annually in billing and insurance-related administrative costs. What’s worse, the U.S. healthcare system incurs these costs regardless of the insurer’s ultimate coverage decision.
Insurance providers themselves are paying an indirect price for their coverage denials as well. The denials are hurting the reputation of the health insurance industry as a whole. While the DPRP survey found that most Americans are satisfied with their insurer, more than two-thirds said that their perception of their provider either had not improved or had gotten worse over the last five years.
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Partisan infighting may have stymied healthcare reform in the short-term, but both sides of the aisle must agree that Americans who have purchased health insurance should at least get the coverage they paid for. But new polling data suggests that one-in-four insured Americans is at risk of being denied coverage for treatment of a chronic or persistent illness, even when they have fully paid their premiums.
Despite years of public debate about overhauling the nation’s healthcare system, the U.S. government cannot say definitely that Americans who purchase health insurance can reasonably expect to be covered when they need it most. The only official, comprehensive data on insurance company treatment denials were compiled in a 2011 Government Accounting Office (GAO) report, which has yet to be updated.
According to a recent consumer survey commissioned by the Doctor-Patient Rights Project (DPRP), however, the health of as many as 53 million insured Americans may be in jeopardy by insurance companies that refuse to cover treatments for chronic or persistent illnesses. The nationwide survey, which polled Americans with private health insurance or coverage under Medicare or Medicaid, revealed an alarmingly high rate of denial—nearly one in four (24 percent) —among patients treating chronic or persistent illnesses.
WASHINGTON – MARCH 10: Desni Crock (L) of Marietta, Ohio, and her three-year-old daughter Bridget (R) attend a forum to tell their stories about denied coverage by insurance companies March 10, 2010 on Capitol Hill in Washington, DC. Bridget was diagnosed with a rare form of lung cancer in 2008 and she was denied with coverage for a more than $35,000 treatment bill in the first two months from an out-of-network hospital. Her current insurance plan only covers 60% of the high cost test and treatment bills with a $12,000-deducible. (Photo by Alex Wong/Getty Images)
Even worse, DPRP’s data indicated that coverage denials disproportionately impact the most vulnerable patients, who need treatment the most. Up to 70 percent of the denied claims, for example, were for treatment of a chronic or persistent illness or condition described as “serious,” and up to 43 percent of the consumers denied described themselves as already “in poor health.”
In most cases, even patients who eventually won coverage of their treatments had to wait more than a month for the insurance company to make a decision. Nearly a third (29%) reported that their conditioned worsened while they waited.
Aside from delaying effective healthcare, the whole process of battling insurers to authorize treatment coverage creates a paperwork nightmare for doctors. The process of seeking prior authorization from insurers and appealing initial denials also contributes to an estimated $471 billion annually in billing and insurance-related administrative costs. What’s worse, the U.S. healthcare system incurs these costs regardless of the insurer’s ultimate coverage decision.
Insurance providers themselves are paying an indirect price for their coverage denials as well. The denials are hurting the reputation of the health insurance industry as a whole. While the DPRP survey found that most Americans are satisfied with their insurer, more than two-thirds said that their perception of their provider either had not improved or had gotten worse over the last five years.
