Frustrated with High Insurance Costs & Claim Denials? CALL YOUR ELECTED OFFICIALS
The murder of United Healthcare CEO Brian Thompson brought American frustration with health insurance into the national spotlight.
As the criminal case continues, politicians say change to a frustrating system comes through legal frameworks— not violence.
“I’m not discounting anyone’s frustration with the health care system,” Pennsylvania Governor Josh Shapiro told press at the state capitol earlier this week. “This is where we make progress. You never make progress by picking up a gun and shooting someone in cold blood."
In a recent Gallup poll, 23% of Americans say the most urgent health problem facing the country is cost. More expensive health care leads to more expensive insurance.
“Yes, inflation is part of it,” Antoinette Kraus said, the executive director of the Pennsylvania Health Access Network. The group is a non profit that helps patients navigate where to get health care access, navigate insurance issues, and more.
“But we're seeing hospital consolidation, which drives up the cost of care. More folks going without coverage. That drives up the cost of care for everyone,” Kraus said. "Or when someone delays care, they end up with more expensive care down the line— and that's passed on to everyone.”
Insurance companies also have a claim denial rate of 17-19% in the United States.
“There's computer algorithms looking at, you know, claims being submitted,” Kraus said. "Maybe they deny that initial claim, and then that gives an opportunity for a doctor to look at different, less expensive options… that may not work as well, right? It’s a lot of things."
Kraus says expensive insurance and claim denials are one part of a fractured system, and that not all blame can be pinned on the companies. Prescription drug prices play a role in insurance costs, and hospital merges often happen with little transparency and ways to track how the merge impacts costs.
There are action steps people can take action against rising costs.
Specifically with claim denials with insurance, every company has a way to appeal a denial.
“Too many people accept an initial denial and think that they don't have other resources,” Michael Humphreys said, Pennsylvania Insurance Department Commissioner. "And that's where we're trying to work with communities to let people know they have internal appeals rights at the company, they have an insurance department that’s here that will advocate for them."
Pennsylvania did reintroduce external appeals to denied claims several years ago. The state averages 13-14% of insurance claims being denied.
Advocates say reversing the general rise in healthcare costs needs grassroots involvement.
“We're so mad at, you know, a pharma company or an insurance company or, you know, your medical bill,” Kraus said. "And I think the more that we contact our policymakers and say, you know, this isn't acceptable, we need to do something about it— the more appetite they'll be to address a lot of the inequities we're seeing in Harrisburg.”