The targeted killing of United Healthcare CEO Brian Thompson in December was a turning point for public dissatisfaction with the health insurance industry. People have begun sharing stories online about how insurance companies are denying their coverage and overturning their lives.
“In the aftermath of the killing of the CEO of UnitedHealthcare, we have seen a national conversation about health insurance barriers: Health Policy and Management at the University of Pittsburgh.
One such patient is Shelby Kinsey, a 22-year-old Texas resident who was diagnosed with ALS last year. She fought the insurance company Texas Blue Cross Blue Shield and secured approval from Qalsody.
“When we were first rejected, we were told it was due to the Blue Cross Blue Shield in Texas. “We made the decision with the help of the medical coordinator at Baylor School of Medicine. I have to file a lawsuit three times.”
“It honestly shocked how difficult this process is to get approval for life support drugs because of illnesses that don't have many options,” she added.
CNBC reached out to Kinsey's insurance provider for comment, but Texas' Blue Cross Blue Shield said it was “not discussing the media and member issues.”
Despite many headlines Report Pointing to an increase in health insurance claim denials, the fragmented nature of the system makes it difficult to get an accurate count.
“It's difficult for health insurance companies to accurately estimate the number of claims denied in a given year, as not all health insurance companies report this data. But we know that There are a few things that we have,” Yaver said. “The Affordable Care Act has done a few things to help make this extremely complex insurance coverage denial process more transparent.”
She said that if an insurance company that says it is regulated by the Affordable Care Act, it is necessary to give reasons, disclose information about the denial, and also to appeal processes. .
“But like many American law and policy narratives, much of this comes down to enforcement,” she added.
Using limited data, published by KFF, a nonprofit organization focusing on health policy January survey In 2023, it showed that 73 million of the claims in the US in its network of 392 million people were denied. In 2021, 48.3 million people in the network of 2,916 million were denied.
In particular, most consumers do not plead for rejection. Less than 1% did, insurers supported 56% of these appeals.
“One of the things we saw in some of the research work we've done to investigate consumers with different insurance types is that we simply don't know that they have the right to appeal,” says Patients and Consumer protection programs. “If the appeal is used more frequently, it could work as a carrier check. But from what we can see now, few people get appealed, so it's like a check. It won't work.”
Watch the video How Americans challenge insurance companies to investigate the rise in claim denials and how to explore current healthcare situations in the United States
