As corporate insurance companies bank record profits by delaying and denying care for patients and buy up physician practices to exert even more control over Americans’ healthcare, a growing chorus of bipartisan voices is expressing serious concerns.
Recent headlines and investigations are shedding light on corporate insurers’ never-ending pursuit of profits at the expense of those who need care most – denying essential care, using algorithms to reject claims en masse, even pressuring staff to deny payments for the sickest patients, all while buying up a growing percentage of America’s physicians.
It’s no surprise that a new poll reveals that voters are concerned about corporate insurance companies’ role in higher healthcare costs and their practice of delaying and denying patients’ care. Policymakers should hold corporate insurance companies accountable and work toward long-term, sustainable solutions to lower healthcare costs.
Delaying and Denying Care
STAT News: “According to a recent investigation by STAT, the ‘nation’s largest health insurance company pressured its medical staff to cut off payments for seriously ill patients in lockstep with a computer algorithm’s calculations, denying rehabilitation care for older and disabled Americans as profits soared.”
KFF: “We find that, across HealthCare.gov insurers with complete data, nearly 17% of in-network claims were denied in 2021. Insurer denial rates varied widely around this average, ranging from 2% to 49%.”
Fierce Healthcare: “A recent KFF study of ACA plans found that even when patients received care from in-network physicians—doctors and hospitals approved by these same insurers—the companies in 2021 nonetheless denied, on average, 17% of claims.”
- “One insurer denied 49% of claims in 2021; another’s turndowns hit an astonishing 80% in 2020.”
- “Despite the potentially dire impact that denials have on patients’ health or finances, data show that people appeal only once in every 500 cases.”
RevCycleIntelligence: “A new analysis of data from over 1,300 hospitals and health systems by Syntellis Performance Solutions and the American Hospital Association (AHA) found a nearly 56 percent increase in Medicare Advantage denials from January 2022 to July 2023.”
Buying Up Physicians Practices To Exert Even Greater Control Over Americans’ Care
STAT News: “UnitedHealth Group has about 90,000 employed or affiliated doctors, approximately 10% of all physicians in the U.S. The number — disclosed Wednesday at the company’s investor day by Amar Desai, the CEO of UnitedHealth’s Optum Health division — means the company acquired or hired 20,000 doctors in the past year alone.”
The New York Times: “So why are multibillion-dollar corporations, particularly giant health insurers, gobbling up primary care practices? CVS Health, with its sprawling pharmacy business and ownership of the major insurer Aetna, paid roughly $11 billion to buy Oak Street Health, a fast-growing chain of primary care centers that employs doctors in 21 states. And Amazon’s bold purchase of One Medical, another large doctors’ group, for nearly $4 billion, is another such move.”
STAT News: “Emanate Health, a nonprofit group of hospitals and physicians in California, filed a federal lawsuit Monday, alleging Optum pushed it to agree not to compete for primary care physicians, a violation of antitrust law.”
- “When the health system refused, Emanate said in its complaint, Optum cut off contracts and steered patients to other providers.”
- “UnitedHealth’s Optum subsidiary, which includes its provider arm, its pharmacy benefit manager, and its data and technology arm, has been especially focused on acquiring provider practices in recent years.”
Growing Bipartisan Concerns
Senator Ron Wyden (D-OR): “‘It was stunning how many times senators on both sides of the aisle kept linking constituent problems with denying authorizations for care,’ Sen. Ron Wyden (D-Ore.) said in an interview, referring to a bevy of complaints from colleagues during a recent Senate Finance Committee hearing.”
Senator James Lankford (R-OK): “But Sen. James Lankford (R-Okla.) said some hospitals in his state won’t take Medicare Advantage plans anymore. ‘We can’t do it because we can’t afford the constant chasing from all the denials,’ he said.”
Senator Elizabeth Warren (D-MA): “Sen. Elizabeth Warren (D-Mass.), who wants the agency to go further, has proposed an amendment that would require CMS to collect and publish data from Medicare Advantage plans on their prior authorization practices to make public the number of prior authorization requests, denials and appeals by type of medical care.”
Senator Mike Crapo (R-ID): “[Warren] has support from Sen. Mike Crapo (R-Idaho), who said during a recent hearing that his support for Medicare Advantage plans ‘does not mean that I like the prior authorization process and that I do not see some problems here that need to be solved.’”
Becker’s Payer Issues: “Lawmakers are putting pressure on CMS to increase oversight of prior authorizations in the [Medicare Advantage] program. Earlier in November, 30 U.S. representatives wrote to CMS Administrator Chiquita Brooks-LaSure, asking the agency to require MA plans to report prior authorization data, including reasons for denials.”