US health insurance companies accused of multiple denials, delays: Surveys

New York: Every year, US health insurance companies deny tens of millions of patient claims for medical expense reimbursements, and the tide of those denials has been rising.

The Washington Post on Monday cited surveys of doctors and other healthcare providers.

Insurers also have been increasingly demanding that doctors obtain approval before providing treatment, similar surveys show, causing delays in patient care that the American Medical Association says are “devastating,” Xinhua news agency reported.

While several states have passed legislation trying to restrict such practices amid growing public anger, insurers defend the coverage denials and “pre-authorisation” requirements. They say those measures are meant to contain rising costs and that their methods comply with federal and state regulations.

“Most frustrating, according to patient advocates, is that insurance companies often act without explanation, sending denial letters that offer only sparse justifications,” said the report.

The patient “gets a cryptic message saying ‘it’s not medically necessary,’ but without any other explanation,” said Elisabeth Benjamin, a vice president at the Community Service Society in New York, which runs a program that helps consumers appeal denials.

“People are mad because it’s all a big secret,” Benjamin said. “It’s unfair for us as a society, on something that’s so visceral, to trust giant corporations that make money when they deny care. This is why people are so, so very angry.”

Exactly why and how often claims are being denied or medical procedures are getting early scrutiny is difficult to know. Nationally over the last five years, the rates of denial have been between 14 per cent and 16 per cent, according to data from the National Association of Insurance Commissioners.

Insurance industry representatives blame doctors for many of the denials, saying they botch the required paperwork by submitting inaccurate, incomplete or ineligible claims information.