Reform Harmful Insurance Practices
Who it Affects
Mass coverage denials and delays put lives at risk while padding the pockets of corporate insurance companies. These companies have made appealing denials so difficult that, on average, fewer than 1% of denials are disputed. When claims are eventually disputed, they often don’t hold up, with one-half of initial denials being overturned.
The Problem
Harmful Practices By Some Big Insurers Restrict Patient Access to Care and Drive Up Costs.
Some corporate insurance companies are misusing technologies like AI and automated processing to deny patients’ claims categorically. Between 2022 and 2023, care denials increased an average of 20.2% and 55.7% for commercial and Medicare Advantage claims, respectively. Meanwhile, these companies have made appealing denials so difficult that, fewer than 1% of denials are disputed. For the appeals that are submitted, one-half (or 50%) of initial denials are overturned.
When claims are eventually disputed, they often don’t hold up. According to a 2018 report from the Department of Health and Human Services, 75% of Medicare Advantage care denials were overturned on appeal between 2014 and 2016.
Our Advocates’ Stories
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Impact of insurance Policies on patients
Harmful Health Outcomes for Patients
Nearly 90% of physicians say they have personally seen burdensome policies from insurance companies negatively affect patients’ clinical outcomes.
Cause Life-Threatening Events
Nearly 20% said they have seen insurance company policies cause a life-threatening event.
Mass denials hurt patients and the hospitals and health systems they rely on for 24/7 care.
Administrative costs related to insurer delays and denials now account for more than 40% of total expenses hospitals incur in delivering care to patients.
50%
$100 Million
Half of all hospitals have more than $100 million in outstanding claims that are older than six months.
35%
Half a Million
One recent study found 35% of hospitals report losing more than half a million dollars every year to denied claims.
Some insurers pile on more liabilities on struggling hospitals to line their own pockets.
Corporate insurers spend billions of dollars acquiring physician practices. Between 2019–2024, commercial health insurers have acquired 40% more physicians than hospitals.
Medicare Advantage plans administered by corporate health insurers often exacerbate threats to care — and cost taxpayers billions.
According to MedPAC, Medicare Advantage will cost taxpayers an extra $76 billion in 2026 compared to traditional fee-for-service Medicare.
But when Medicare Advantage denials are appealed, they are usually overturned. According to a 2026 report from the Kaiser Family Foundation, 81% of Medicare Advantage care denials were overturned on appeal in 2024.
The Solution
A growing number of lawmakers on both sides of the aisle are criticizing Big Insurance for driving up healthcare costs and endangering patients. Policymakers should continue to come together to improve patient access to timely care and work toward long-term, sustainable solutions to lower healthcare costs.