Hospitals speak out against corporate health insurance

Americans have a new ally in the fight for health care reform. The American Hospital Association is speaking out against corporate health insurance. Hospitals are feeling the squeeze from corporate health insurers and making clear that patient safety is at risk, as costs increase.

With nearly half of the Medicare population now enrolled in corporate health insurance plans–Medicare Advantage–hospitals are increasingly dealing with corporate health insurer shenanigans. It comes in many forms.

• Insurers often require prior authorization when it can delay patient care and jeopardize health, while also raising administrative costs for providers.
• Insurers often require patients to get less expensive treatment that physicians know will not work before agreeing to cover the care people need. They are using “step therapy” or “fail-first policy”  more frequently in order to save money. At the same time, these policies add to administrative costs for providers as well as keep people from getting the care they need.
• Insurers often design coverage policies that override physicians as to care that is medically necessary.
• Insurers often prevent physicians and hospitals from treating patients with medications they have in stock–“white bagging”–and require them to use medications from an outside pharmacy.  This practice can harm patient safety.
• Insurers use electronic payment methods that sometimes require hospitals to pay money in order to receive reimbursement.

The American Hospital Association recognizes the need for Congressional fixes. Unfortunately, short of ending the filibuster or having 60 Democratic votes in the Senate, meaningful fixes will not happen.

1. The AHA wants to measure unnecessary administrative costs resulting from corporate health insurer requirements that are inappropriate.
2. The AHA wants standardization and reform of administrative policies in order to reduce the large administrative burden on providers and their patients.

NB: A bi-partisan bill in the House of Representatives would appear to improve the prior authorization process. While it has many good provisions, it includes no penalties for insurers that fail to comply. Apparently, had the bill included penalties for non-compliance it would not have bi-partisan support.

Until we stop insurers from gaming the system to the detriment of patient health, it is likely that administrative obstacles to care will continue, that health insurance costs will continue to increase, that more patients will not be able to afford health care, and that more hospitals will fail. Insurance premiums alone are up 47 percent since 2011.

Here’s more from Just Care:

• Medicare seeks to stop disclosing hospital safety information
• Hospitals still not disclosing their prices, violating the law
• Coronavirus: Biden administration fails to disclose hospital bad actors
• Medicare hospital star-ratings are a farce
• One in four people with Medicare harmed in hospital