Robins Fields reports for Pro Publica on the serious challenge facing anyone, including people with Medicare, trying to choose health insurance. There is no way for them to know which corporate health plans deny care frequently; some of these health plans have super high denial rates that can put the health and well-being of their enrollees at risk. So, if you’re choosing among Medicare Advantage plans, the corporate health plan alternative to the government-administered traditional Medicare option–which has a very low denial rate– beware.
As Fields explains in her story, people need to know about health plan denial rates in order to make an informed choice. After all, you’re buying insurance to ensure that when you need care, you can get it and, when you need care urgently, you can get it swiftly, without worry about the cost. But, even though reports show that some health plans deny as many as one in three requests for coverage, jeopardizing access to care for people in those plans, you can’t know which ones those are.
The problem of not knowing about Medicare Advantage plan denial rates is most acute when you are diagnosed with a complex and costly condition and need a lot of care. Will you get to the oncologist before your cancer spreads? Will your health plan even cover the tests you need to see whether you have cancer?
Fields tried to get the information on health plan denial rates without any success. What’s so troubling is that this information should be easily accessible but neither the federal government nor state governments have tried to correct it. Pro Publica has already exposed how top insurers deny claims speedily and even in bulk in some cases. So, it’s clear that people need protection from these insurers.
Of note, the Affordable Care Act legislation gives federal regulators authority to force insurers to turn over health plan denial information. But, more than ten years later the federal government has not collected helpful information.
Fields reports that only two states collect some health insurer denial rates for public scrutiny. Unfortunately, they don’t collect data on most health plans.
As Karen Pollitz, a researcher at Kaiser Family Foundation reports, “This is life and death for people: If your insurance won’t cover the care you need, you could die.” “It’s all knowable. It’s known to the insurers, but it is not known to us.. . . The insurers are not wanting to disclose this information and push back when asked for it. They claim it imposes burdens that “outweigh the benefits for consumers.”
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