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Everyone blames greedy health insurance companies for increasing claim denials and barriers to care. That’s innocent. Follow the money to find the real culprits: Politicians lie.
This was in 2013, before the Affordable Care Act rules took effect. Insurance companies deny about 1.5% of claims, according to the American Medical Association, but under the ACA rules, denials increased tenfold. Nearly 15% of claims are now denied, reports Premier, an insurance consulting firm. Some insurance companies deny a third or more of claims. According to research from the Kaiser Family Foundation
Insurance companies also require prior authorization for many treatments and medications. doctor’s hands tied and dangerously delay your care.
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Your doctor must call your insurance company before starting treatment or prescribing medication. Rarely is the person on the other end of the phone an expert on the disease or treatment in question. The AMA warns that it may be the OB-GYN that overrides what your neurosurgeon recommends.
Anger at health insurance companies is misplaced. People should hold politicians accountable for their problems. (Istock)
Dr. Debra Pratt prescribes a combination drug for patients with metastatic breast cancer. But she had to wait several weeks to get permission. In the meantime, the AMA reports, she had to pay for standard chemotherapy. To no avail, her patient died.
“You have health plan representatives who never meet with patients. Never stayed at the bedside or received medical attention. But treatment decisions are now being made,” said Tina Grant, senior vice president of public policy and advocacy at Trinity Health, a system of 92 Catholic hospitals.
According to testimony from the House Energy and Commerce Committee, 80% of pre-approvals denied by Cigna for Medicare Advantage customers were overturned on appeal. This is a sign that legitimate care is being withheld. Cigna uses an algorithm called PxDx to deny many previous authorizations.
Previous denial and authorization requirements increased after the ACA took effect. But don’t blame profit maximization. The ACA regulates underwriting profits. And if profits increase Insurance companies must pass on discounts to customers.
Giant companies like United Healthcare have grown into revenue-generating giants by buying up doctor’s offices, hospitals, and drugstore chains. Not by selling health insurance plans. According to IBISWorld industry research
The real reason your health insurance is unreliable is that the politicians who support Obamacare know they have made promises that are impossible to keep without insurance companies resorting to predatory practices.
Supporters of Obamacare promise that everyone will be charged the same amount regardless. “Pre-Existing Conditions”
The math doesn’t work. Every year 5% of the population uses more than 50% of their health care. That’s a fact of nature. Apart from politics
Politicians such as President Barack Obama pressed for Obamacare, knowing it would be difficult for insurance companies. FILE: Obama celebrates after accepting his party’s nomination during the bipartisan national convention. Democrats in Charlotte North Carolina on Thursday, September 6, 2012 (Photo by Christopher Evans/MediaNews Group/Boston Herald via Getty Images)
Telling insurance companies to pay the same 5% premium they charge healthy people is like providing monthly groceries to a skinny fashion model and hot dog-eating contest winner. Nathan’s for the same price. Ridiculous.
Premium payers increased by five percent and medical needs increased by 50 percent.
The federal government should step in and provide extra payments to cover people with pre-existing conditions. Instead, the insurance company was hit with a huge new claim and ordered to take further action. They adopted strict cost-cutting methods.
Winner? democratic politician Covering pre-existing conditions at no additional cost is popular.
Loser? Others worry that their next treatment will be delayed or their next claim denied.
Unfortunately, the biggest losers are seriously ill patients, who suffer disproportionately from the tight controls of managed care. According to the National Bureau of Economic Research on Medicaid managed care.
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More than half of states are now passing laws to limit prior authorization.
That’s a step in the right direction. But Americans need to reevaluate managed care.
Previous denial and authorization requirements increased after the ACA took effect. But don’t blame profit maximization. The ACA regulates underwriting profits. And if profits increase Insurance companies are required to pass on discounts to customers.
There is no evidence that it improves health.
President Joe Biden’s assistant secretary for health policy boasts that the ACA’s expansion of coverage, mostly in managed care, reduces “morbidity and death.” That’s a blatant lie. Americans are sicker and living shorter lives than they did before the ACA.
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One option is to allow low-cost catastrophe insurance. This only applies to large expenses. Healthy people who are covered at work will benefit from fewer interactions with insurance companies. and higher take-home pay instead of a $25,000 insurance plan. This is the cost for family coverage this year.
Democrats are trying to call catastrophic coverage “junk insurance.” The Biden administration is making it nearly impossible to buy. But Americans are beginning to see that health insurance plans that deny claims and make you wait a long time to get pre-approval are real “junk.”
Click here to read more from BETSY McCAUGHEY.
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