7/19/23 NY Times: Insurers Deny Medical Care for the Poor at High Rates, Report Says
Some excerpts:
Private health insurance companies paid by Medicaid denied millions of requests for care for low-income Americans with little oversight from federal and state authorities, according to a new report by U.S. investigators published Wednesday.
Medicaid, the federal-state health insurance program for the poor that covers nearly 87 million people, contracts with companies to reimburse hospitals and doctors for treatment and to manage an individual’s medical care. About three-quarters of people enrolled in Medicaid receive health services through private companies, which are typically paid a fixed amount per patient rather than for each procedure or visit.
The report by the inspector general’s office of the U.S. Department of Health and Human Services details how often private insurance plans refused to approve treatment and how states handled the denials.
Doctors and hospitals have increasingly complained about what they consider to be endless paperwork and unjustified refusals of care by the insurers when they fail to authorize costly procedures or medicines…The investigators also raised concerns about the payment structure that provides lump sums per patient. They worried it would encourage some insurers to maximize their profits by denying medical care and access to services for the poor...
The investigators emphasized the insurers were much more aggressive in refusing to authorize care under Medicaid than under Medicare…Unlike with Medicare, if an insurer refuses to authorize a treatment, patients are not automatically provided with an outside medical opinion as part of their appeal...
The investigators also found that state oversight of coverage denials was lax. Many states do not routinely examine the insurers’ denials nor collect information about how many times a plan denies requests for prior authorization...
The denial rates recorded by the investigators varied widely by insurer and by state.
My take: This is more evidence of the distorted incentives in U.S. healthcare where health insurance companies profit when patients are denied beneficial care.
Related blog posts:
- How Insurance Companies Save Millions in Denying Care
- No One Would Design U.S. Healthcare System This Way
- “Health Insurance Is Broken”
- “We Need More Information to Process This Claim”
- Healthcare: “Where the Frauds Are Legal”
- “Socialism” is Already Here & Increasing in U.S. Health Care
- Consolidation and Competition in Health Care
- The Consequences of Prior Authorizations
- “Denials, Dilly-dallying and Despair”
- “How Can You Tell If You Have Good-Quality Health Care?”
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