June 15, 2023
Health insurance providers, it seems, are as cruel as ever, as evidenced by a letter sent to a newborn’s family denying the infant coverage for neonatal care in an intensive care unit (NICU), reports Futurism.
In an editorial for the The Washington Post, Kaiser Family Foundation senior contributing editor Elizabeth Rosenthal described the problem of insurance claim denials in the starkest terms: by providing examples of real letters people had gotten denying them and their loved ones coverage. One such letter, sent directly to a newborn baby, was so absurd that—if it weren’t real and published in WaPo—we would think it was satire.
This issue, the KFF editor noted, goes all the way back to the drafting of the Affordable Care Act during President Barack Obama’s first term.
“Because the law prohibited insurers from deploying a number of previously profit-protecting measures such as refusing to cover patients with preexisting conditions,” she wrote, “the authors worried that insurers would compensate by increasing the number of denials.”
The Department of Health and Human Services was supposed to monitor insurance claim denials on Obamacare marketplace plans. Instead, arbitrary and cruel denials like the aforementioned became more common, Rosenthal wrote.
There are, previous research has found, a number of reasons for this ever-increasing trend.
In March, Rosenthal noted, ProPublica published the results of an investigation into the insurance giant Cigna, which employs an automated claims-approval system that allowed “medical reviewers to sign off on 50 charts in 10 seconds presumably without even examining the patients’ records.”
Another salient change: over the past decade, insurance has begun being employed for everything from inhalers to heart medication, when before, “insurers’ reviews were reserved for a tiny fraction of expensive treatments to make sure providers were not ordering with an eye on profit instead of patient needs.”
“Automation makes the reviewing cheap and easy,” Rosenthal said—even as shifting relationships with drug companies make it ever more complicated on a claim-by-claim basis.
The Department of Health’s refusal, in essence, to comply with the law tasking it with insurer denial oversight has allowed insurance giants to get away with this barbaric practice for more than a decade—and as Rosenthal argued, a bit of government strongarming seems more than due.
“The government has the power and duty to end the fire hose of reckless denials that are harming patients financially and medically,” she wrote. “Thirteen years after passage of the ACA, perhaps it is time for the mandated investigation and enforcement to begin.”
Research contact: @futurism