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Everyone blames the greed of health insurance companies for the surge in claim denials and barriers to health care. That’s naive. Follow the money and find the real culprit – the politician who lied.
In 2013, before the Affordable Care Act, insurers denied about 1.5% of claims, according to the American Medical Association. But under the ACA rules, denials increased tenfold. Currently, nearly 15% of insurance claims are rejected, reports insurance consultancy Premier. Some insurance companies deny more than a third of claims, according to research by the Kaiser Family Foundation.
Insurers also require prior authorization for a wide range of treatments and medications, tying doctors’ hands and dangerously delaying treatment.
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Your doctor must call your insurance company before starting treatment or ordering any medication. The person on the other end of the phone is rarely an expert on the disease or treatment in question. Obstetricians and gynecologists may override neurosurgeons’ recommendations, the AMA warns.
Anger against health insurance companies is misplaced. The people should hold politicians accountable for the problems they have caused. (St. Petersburg)
Dr. Debra Patt prescribed the combination drug to patients with metastatic breast cancer, but had to wait several weeks for prior approval. In the meantime, she had to settle for standard chemotherapy, but to no avail, and her patient died, the AMA reports.
Tina Grant, senior vice president of public policy and advocacy at Trinity Health, a 92-person hospital, said, “We have a health insurance executive who has never met a patient, never been at the bedside, never performed a medical procedure.” “The patient is now deciding the treatment method.” Catholic hospital.
Eighty percent of Cigna’s prior authorizations denied to Medicare Advantage customers are overturned on appeal, a sign that legitimate care is being withheld, according to testimony before the House Energy and Commerce Committee. Cigna uses an algorithm called PxDx to deny prior approvals in bulk.
After the ACA went into effect, denial and preapproval requirements escalated. But don’t blame profit maximization. The ACA regulates underwriting profits, and if profits increase, insurance companies must send rebates to customers.
IBISWorld’s industry research shows that giant companies like United Healthcare became money-making behemoths not by selling health plans, but by acquiring physician practices, hospitals, and pharmacy chains.
The real reason you can’t trust your health insurance is because politicians who supported Obamacare made promises they knew were impossible to keep unless insurance companies resorted to predatory practices. be.
Obamacare supporters promised that everyone would be charged the same price regardless of “pre-existing conditions.”
Mathematics doesn’t work. Each year, 5% of the population uses more than 50% of health services. That’s a fact of nature, politics aside.
Politicians like President Barack Obama pushed for Obamacare knowing it would be difficult for insurance companies. File: President Obama accepts and celebrates his party’s nomination at the Democratic National Convention in Charlotte, North Carolina, Thursday, September 6, 2012. (Photo by Christopher Evans/MediaNews Group/Boston Herald, Getty Images)
Telling insurance companies to pay 5% at the same price they charge healthy people is the same as giving skinny fashion models and Nathan’s Hot Dog Eating Contest winners the same amount of monthly groceries. It’s like offering at a price. That’s ridiculous.
There was a 5% increase in premium payers and a 50% increase in medical needs.
The federal government should have provided additional benefits to cover people with pre-existing conditions. Instead, insurance companies were hit with a mountain of new claims and told to make it work. They adopted strict cost-cutting techniques.
Who is the winner? Democratic politician. Services that cover existing conditions at no additional charge are popular.
loser? Everyone else who is worried that their next treatment will be delayed or their next claim denied.
Sadly, the biggest losers are the seriously ill who suffer disproportionately from the strict controls of managed care, according to a National Economic Research Service paper on Medicaid managed care.
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Currently, more than half of states have passed laws restricting prior approval.
That’s a step in the right direction. But Americans need to reevaluate managed care.
After the ACA went into effect, denial and preapproval requirements escalated. But don’t blame profit maximization. The ACA regulates underwriting profits, and if profits increase, insurance companies must send rebates to customers.
There is little evidence that it improves health.
President Joe Biden’s assistant secretary for health policy boasts that the ACA’s expanded coverage (primarily managed care) has reduced “morbidity and mortality.” That’s a blatant lie. Americans are sicker and living shorter lives than before the ACA.
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One alternative is to allow low-cost catastrophe insurance, which only applies in the case of large claims. Healthy people who buy insurance at work will benefit from fewer interactions with insurance companies and more take-home pay instead of a whopping $25,000 plan, which is the cost of family insurance this year. It will be.
Democrats are trying to label catastrophic insurance “junk insurance.” Since the Biden administration took over, it has become almost impossible to purchase. But Americans are beginning to realize that health insurance that denies claims and makes people wait dangerously long periods of time for pre-approval is the real crap.
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