Millions of Americans are increasingly finding themselves at the mercy of commercial insurance companies that are arbitrarily denying their claims. These insurance giants, rejecting claim after claim without valid reasons, are forcing American patients to shoulder significant financial and emotional burdens, in addition to their serious health issues. Once designed to serve the best interests of patients, some of these companies have turned their backs on the ones they were meant to protect. A recent analysis by the Kaiser Family Foundation reveals that, on average, insurance companies deny 1 in 5 claims. Some insurers reject as much as 49 percent, with one shocking example rejecting 80 percent of claims. Cigna, a major health insurer with 20 million customers and $195 billion in revenue last year, was caught denying claims without even reviewing patients’ files.
The issue is not limited to traditional insurance plans. Medicare Advantage plans, designed to offer more choices and comprehensive benefits, now cover more than half of all Medicare beneficiaries. Unfortunately, these plans are also plagued by an overwhelming number of prior authorization requirements and coverage denials. Each year, more than 1.5 million Medicare Advantage prior authorizations are improperly denied, according to KFF, and that number is only growing with every coming year. The Inspector General for the Department of Health and Human Services documented nearly 640,000 denials in 2019, with that number skyrocketing to 2 million in 2021 alone. For example, UnitedHealthcare, the nation’s largest health insurer with over 50 million customers and the largest share of Medicare Advantage enrollment, denies at least 2 million Medicare Advantage prior authorization claims annually. This is a very alarming number considering the critical role these types of claims play in ensuring the elderly receive the proper care they deserve.
Last year, unfortunately, UnitedHealthcare was sued for using an artificial intelligence algorithm to wrongfully deny care to elderly patients under Medicare Advantage plans. The algorithm, known to have a 90 percent error rate, led to patients being prematurely discharged from care facilities, disrupting their lives and putting their health in jeopardy. Unfortunately, the elderly are not the only vulnerable community affected by these insurance denials. Prior authorization requirements, along with insurance denials, disproportionately affect minority and underserved lower-income populations. A 2022 study found that Black cancer patients were three times more likely to be denied health insurance compared to their white counterparts. This racial disparity underscores the urgent need for reform to ensure equitable access to healthcare for all. For too long, some insurance companies have amassed enormous profits at the expense of patients, providers, and hospitals. It’s time we prioritize patients over profits and hold these corporate giants accountable. This critical issue must be addressed by implementing stricter regulations and oversight on insurance claim denials can provide much-needed relief and justice to millions of Americans. Our healthcare system should be a source of support and healing, not a battleground for patients to fight for the care they deserve.
The Honorable Edolphus “Ed” Towns Jr. is an American educator, military veteran, and former member of Congress who served in the United States House of Representatives. A Democrat from New York, Towns was Chairman of the House Oversight and Government Reform Committee. Towns was an administrator at Beth Israel Medical Center, a professor at New York’s Medgar Evers College and Fordham University, and a public school teacher teaching orientation and mobility to blind students.
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