Health insurance has long been considered a means to help individuals and families pay for medical care and protect their health. But some giant corporate insurers have shown they are more committed to looking out for their bottom lines than looking out for patients. Now, a new report adds to the growing body of evidence that huge insurance companies are using questionable tactics to delay and deny patients’ medical care to pad their own corporate profits.
Nearly one in five respondents (17%) said their insurance plan has denied coverage for a doctor-recommended medical service or procedure according to a recent report by the Commonwealth Fund. And nearly half of patients who were refused coverage for care said their health deteriorated as a result.
“[Insurers] are becoming increasingly adept in using technology to deny payment of medical claims and pressure their company physicians to deny care during prior authorization reviews,” the Commonwealth Fund states. Some giant insurers are even using technology like Artificial Intelligence to make claim denials even faster and even more arbitrary — at patients’ expense. Meanwhile, “doctors also report spending increasing amounts of time on the phone with insurance company physicians over denials of care for their patients.” Physicians spend about twice as much time on paperwork and administrative requirements as they do with patients, according to the American Medical Association. More than nine in ten physicians report feeling “burned out,” and over 60% say excessive administrative burdens are the primary cause.
Insurers denied more than 49 million medical claims in 2021, PBS reported last year, and less than 0.2% were challenged. Some corporate insurers have even leveraged their market power to drive questionable diagnoses and charge for treatments that were never delivered. The Wall Street Journal reported that these claims, which often “neither the patients nor their doctors had any idea” about, drained $50 billion from Medicare.
To distract from their strategies, some corporate insurers and special interest groups have sought to shift blame on to hospitals. These groups are advocating in Washington for major cuts to hospital reimbursements which would slash billions of dollars from patient care. These cuts could force many hospitals to reduce or eliminate services, threatening Americans’ access to 24/7 care.
These corporate insurers’ tactics are “ethically nuts,” says Dr. Arthur Caplan of the Medical Ethics Division at New York University’s Grossman School of Medicine. “We’re letting the people who have the pocketbooks and the wallets have prior approval of what the doctor thinks is correct. That is really not the way to practice medicine.”