Media is only Focused on United Healthcare CEO - Why Aren't They Equally Focused on the Healthcare Denials Killing & Bankrupting Healthcare Customers?
Corporate Greed Over Healthcare Accountability - What's Awaiting America in 2025...?
For anyone who has struggled through the nightmare of understanding and navigating healthcare billing codes and the rationale for insurers rejecting claims for medical payment and reimbursement for services - the recent killing of a United Healthcare CEO not only makes sense, it should be a wake-up call to all healthcare insurers: there are consequences to their greed. Now more than ever, there is a clear message that their outrageous bottom line of profit over people - profits at all costs, is not shared by the public. It is a clarion call to action for: insurers, medical providers - and the media - hearkening them to pay close attention, and fix a long overdue problem.
No Secrets…
It is no secret that older Americans make more trips to the doctor and the hospital than their younger counterparts. It is also no secret, for most aging Americans, their resilience to battle rejections on “covered services” and out-of-pocket payment, is also waning - of which their health insurers are fully aware. This is a feature of health insurer CEO’s time-proven “healthcare coverage model” using actuarial statistics employing the laws of attrition to: “delay,” “deny” and “depose” withholding and delaying payment to claimants all while the insurer collects interest on monies wrongly withheld and delayed. This methodology is also bankrupting hospitals and medical establishments who must regularly meet payroll. It is no wonder the shooter inscribed this on the bullets that killed the United Healthcare CEO.
It is also no secret, that this delay, deny and depose model of payment retention is used to disadvantage the already disadvantaged, reject their claims, so in all likelihood, the claimant can’t, won’t, forget, or are for whatever reason, unable to resubmit their claim for appeal. And we all know medical bankruptcies are still all too common - despite the assistance provided by the Affordable Health Care Act (ACA). Currently, medical debt is crushing over 100 million Americans.
The Process of Denial and Statistical Attrition After First Denial:
What insurance companies do, is wear-out those who submit claims through code jargon, coverage loopholes, and simply denying coverage altogether. There is every indication these insurers reject first and ask questions later - they do it because it works. The attrition rate is staggering as to how many people actually give up before their claim is fully processed and paid. In other words, it pays for insurers to wear-down the claimant, so that the claim will eventually be written-off, and the insurer keeps the cash. Even more troubling, the high cost to health care providers - those who actually provide the medical services to obtain reimbursement from insurers shows no signs of abating. All of this driving the cost of healthcare and healthcare billing through the roof.
A recent publication by the American Hospital Association (AHA), spotlights a report from the group purchasing and consulting organization Premier highlights on this long-standing problem.
As for Premier data collection, it found that:
Hospitals and health systems spent an estimated $19.7 billion in 2022 trying to overturn denied claims.
Denied claims tended to be more prevalent for higher-cost treatments, with the average denial pegged to charges of $14,000 or more.
Nearly 15% of all claims submitted to private payers initially are denied, including many that were preapproved during the prior authorization process. Overall, 15.7% of Medicare Advantage and 13.9% of commercial claims were initially denied.
More than half of denied claims (54.3%) by payers ultimately were overturned but typically only after providers went through multiple rounds of costly appeals.
Sadly, it’s not getting better.
Hospitals Getting Hit Hard as They Struggle to Get Reimbursement
This finding by Premier closely track with the AHA's most recent survey that was conducted between December 2021 and February 2022. That survey disclosed that a staggering 78% of hospitals reported that their experience with commercial payers was getting worse.
Moreover, 84% of respondents said the cost of complying with insurer policies was increasing and 95% of hospitals and health systems reported that their staffs were spending more time on prior approval processes. Respondents also said that 62% of prior authorization denials and 50% of initial claims denials that were appealed were overturned.
The impact of some payer policies can cause dangerous delays in patient care, result in undue burden on providers and add billions of dollars in unnecessary cost to the nation’s health care system.
As health care organizations continue to face financial headwinds this year, the strategic imperative to manage claims denials effectively has become a higher priority in many organizations.
According to Stat News health care stocks are doing well, despite a market stumble in 2023:
“Health care stocks stumbled compared with the rest of the market in 2023. Companies missed their profit targets. Some CEOs even lost their bonuses.” … Could it be the '“stumble” was because their “profit targets” were set too high?
But the biggest names in health care still made $3.5 billion combined last year, compared with $4 billion in 2022. The average chief executive brought home $11 million, while the median was $4.1 million. Those figures compared to an average of $13 million and median of $4.3 million in 2022.
As reported by USBank.com, healthcare stocks in 2024:
S&P's estimates project healthcare stocks will generate earnings growth of 10.2% in 2024, outpacing earnings growth expectations for the broader S&P 500.
Stocks Rising and Healthcare Execs Doing Well…So What Say You CEO’s?
So if there is so much profit for the C-Suite Execs, why not spread a little around to help the people who actually need the help to pay for their healthcare? Greedy is the only synonym for ‘gluttonous’ that comes to mind - one of the Seven Deadly Sins of Christianity, not least of all, coveting what belongs to another - also breaking the Tenth Commandment - through unmitigated avarice and greed. That’s if they even care.
The Consumer Protection Bureau (CFPB) Helping Consumers Navigate Expenses
The CFPB is working to stop unfair medical debt collection and coercive credit reporting practices that add to the strain on American families. According to the Bureau - which Elon Musk wants to eliminate - the CFPB (the brainchild of Sen. Elizabeth Warren), helps Americans navigate through this retaliatory process.
The CFPB currently finds:
$88 billion of outstanding medical bills are currently in collections – affecting one in five Americans. Their infographic has tips for navigating the complex medical billing and collections system.
In “Strategies to Counter Payer Denial Tactics,” experts from the revenue-cycle management firm CorroHealth explore innovative strategies to counteract the increasing denial tactics used by Medicare Advantage payers.
In “FAQs: Payer Escalations & Strategic Denials Management,” CorroHealth leaders address issues such as:
How to identify the impact of payer denial tactics and strategies to hold payers accountable.
Effective methods for managing DRG (diagnosis-related group) downgrades, denials and appeals; leveraging analytics for strategic decision-making; and revenue management.
Actionable insights for specific challenges.
The Bottom line..
Insurance Companies have been playing god with peoples’ lives for a very long time. Denying Coverage, Denying Care, Flouting Accountability - all in the Name of Profits and Greed. Luigi Mangione may not have gone about bringing attention to the fleecing and subjugation of Americans by health insurers in the right way, but he certainly did shine a floodlight on the inequities - bringing what is usually a personal and silent struggle for many, to light. The big question is, Who’s going to make the system right? Who’s gonna make it work for the people? Is the media going to investigate the corruption? And what if anything will government regulators do? And most importantly, What if anything will the Trump administration do to curtail these abuses on the dawn of their new administration?
A Plan?
We know Trump has ‘concepts of a plan’ - regarding healthcare that has never been revealed, or perhaps doesn’t even exist. And we know he despises everything Obama did, including the creation of ObamaCare (aka the ACA, Affordable Care Act) even though it provides medical coverage to millions of Americans. Coverage many could not afford or obtain: insurance for those with pre-existing illness, illness predating signing on for insurance.
Nevertheless, come January 20, 2025, Americans with unrectified medical bills, issues surrounding denial of care, and pending medical debt bankruptcies, will soon find out if help is on the way. That is, if Trump will be sending the cavalry to save them from the box canyon of unrequited medical debt and mire, or abandon them to the coyotes of corporate governance and greed.
We have a little over 30 days to start finding out…
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