Health insurer claims denials have become increasingly 'arbitrary and absurd': author

17 May 2023

When President Barack Obama signed the Affordable Care Act of 2010 into law, Democrats were hoping to end health insurance companies' worst abuses in the United States. The ACA, a.k.a. Obamacare, isn't universal healthcare, but it has brought insurance to millions of Americans who didn't have it before.

Moreover, Obamacare has grown in popularity despite countless GOP efforts to repeal it. In 2022, a Kaiser Family Foundation poll found that 55 percent of Americans had a favorable view of the law; among Democrats, that number jumped to 87 percent.

But critics of the United States' healthcare system, including Sen. Bernie Sanders (I-Vermont), have stressed that the U.S. still lags behind the rest of the developed world in health outcomes. And in an op-ed published by the Washington Post on May 17, author Elisabeth Rosenthal — a senior editor at KFF Health News — slams health insurance companies for denying numerous claims they should be accepting.

"Millions of Americans, in the past few years, have run into this experience: filing a health-care insurance claim that once might have been paid immediately but instead, is just as quickly denied," Rosenthal laments. "If the experience and the insurer's explanation often seem arbitrary and absurd, that might be because companies appear increasingly likely to employ computer algorithms or people with little relevant experience to issue rapid-fire denials of claims — sometimes bundles at a time — without even reviewing the patient's medical chart."

Rosenthal adds, "A job title at one company was 'denial nurse.' It's a handy way for insurers to keep revenue high — and just the sort of thing that provisions of the Affordable Care Act were meant to prevent."

Rosenthal, who described problems in the U.S. health care system in her 2018 book, "An American Sickness: How Healthcare Became Big Business and How You Can Take it Back," notes that according to KFF research, health insurance companies denied, on average, 17 percent of claims in 2021.

"Sometimes, the insurers' denials defy not just medical standards of care, but also, plain old human logic," Rosenthal warns.

KFF's complaints come at a time when Sanders is making an aggressive push for greater healthcare funding.

According to a Politico report published on May 17, Sanders has launched a plan to "pour nearly $200 billion of new money into the healthcare system."

The Vermont senator told Politico, "The goal right now is to take bold action to increase our healthcare workforce, to make sure that everybody in this country has access to a doctor or a dentist or nursing. If we agree that there is a crisis, if we agree that inaction will only make the crisis worse, do we have the political will to do what we have to do for the American people?"

Find Elisabeth Rosenthal's full Washington Post op-ed at this link (subscription required) and Politico's Bernie Sanders report at this link.

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