Betsy McCaughey: Dont blame insurers greed government made a mess of our health care
Everyone’s blaming health insurance-company greed for soaring costs, rising claims denials and daunting roadblocks to care. That’s naïve. Follow the money to find the real culprits: lying politicians.In 2013, before Affordable Care Act regulations kicked in, insurers denied roughly 1.5% of claims, according to the American Medical Association.But under ACA rules, denials increased tenfold.
Now nearly 15% of claims are denied, reports Premier, an insurance consultant firm. Some insurers deny a third or more of claims, according to Kaiser Family Foundation research.Insurers are also increasingly demanding pre-authorizations for a wide range of treatments and medications, tying your doctor’s hands and in some cases dangerously delaying care.Your doctor has to call the insurer before beginning treatment or ordering a medication — and seldom is the person on the other end of the phone a specialist in the disease or treatment in question. It could be an ob/gyn overriding your neurosurgeon’s recommendation, warns the AMA.Dr.Debra Patt, an oncologist in Austin, Texas, told the AMA she prescribed a drug combination for a patient with metastatic breast cancer, but had to wait weeks for pre-authorization.In the meantime, she had to settle for ordinary chemotherapy, a substandard treatment for the case.
Her patient died.“You have health plan representatives who have never met the patient, have never been at the bedside or practiced medicine, but are now making treatment decisions,” objects Tina Grant of Trinity Health, a nationwide chain of 27 Catholic hospitals.Moreover, according to House Committee on Energy and Commerce testimony, 80% of preapprovals that Cigna denied for Medicare Advantage customers were overturned on appeal — a sign that legitimate care is being withheld. Cigna uses an algorithm called PXDX to deny prior authorizations in bulk. Denials and prior authorization requirements escalated after the ACA went into effect.
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