This Patient Access Week, Hold Corporate Insurers Accountable for Delaying and Denying Care

WASHINGTON – Patient Access Week (March 31 to April 6) serves as a reminder of the importance of protecting and strengthening patient access to 24/7 care across the country. Unfortunately, some corporate insurance companies continue to threaten access to care by delaying and denying necessary patient care.

• Many corporate insurance companies routinely reject claims for necessary care to boost their bottom line. Through the excessive and inappropriate use of prior authorization, they delay and deny important care at the expense of patients.
  • Almost 90 percent of physicians reported that corporate insurance companies’ inappropriate use of prior authorization led to a “negative impact on patient clinical outcomes.”
  • The New York Times Opinion recently reported that one in three doctors say prior authorization has “caused a serious medical issue or even the death of one of their patients.”
  • The Washington Post explained that the prior authorization process “can be confusing and lengthy. Denials are common and appeals are often difficult to navigate. Doctors say some people end up dying while waiting for an insurer’s permission for care.”
  • An NBC news investigation revealed that corporate insurance companies “routinely reject claims for necessary care” for Medicare Advantage patients.

• When corporate insurers delay and deny care, patients can suffer, and hospitals and health systems shoulder the financial burden.
  • A recent Premier survey revealed that hospitals and health systems spend nearly $20 billion annually fighting denied insurance claims.
    • The survey results showed that 54 percent of the claims initially denied by corporate insurers were eventually overturned, but “only after multiple, costly rounds of provider appeals.”

• Fifty percent of hospitals report having more than $100 million in outstanding claims older than six months.
• In one survey, 35 percent of hospitals and health systems reported “$50 million or more in foregone payments as a result of denied claims once appeals have been exhausted.”
• Meanwhile, a recent report by the Medicare Payment Advisory Commission (MedPAC) uncovered that Medicare Advantage is projected to cost taxpayers $88 billion more in 2024 than the government would have spent through traditional Medicare.

Patient Access Week is an important reminder that policymakers must take action to protect patients from those corporate insurance companies that prioritize profits by delaying and denying necessary patient care. It’s time for corporate insurers to stop impeding patients’ access to care and instead let hospitals and physicians do what they do best: provide vital, 24/7/365 care to patients when and where they need it.