Medical Bill Struggles and Denied Claims: The Crisis in America’s Healthcare System
TL/DR –
Many Americans struggle with medical bills due to inadequate health insurance coverage or claim denials. Insurance companies reportedly deny between 10% and 20% of health care claims they receive, with about 1 in 5 adults stating their insurer denied a claim in the past year. The frustration mainly stems from insurers, not patients or doctors, making key health care decisions; reasons for denials range from the treatment not being covered by insurance, not deemed medically necessary, lack of prior authorization, or the physician not being in the insurer’s network.
Struggle to Afford Medical Bills in America: Insufficient Insurance or Denied Claims?
Countless Americans are battling astronomical medical bills due to insufficient health insurance or private insurers rejecting claims. After the UnitedHealthcare CEO’s recent tragic incident, a surge in social media uproar highlighted frustrations with America’s health care system.
Denied Health Care Claims: A Closer Look
Insurance companies reject between 10% and 20% of health care claims, as reported by ProPublica. Meanwhile, KFF notes that almost one-quarter of adults who regularly use health care had claims denied. These rejections are often due to coverage limitations, perceived lack of medical necessity, or failure to obtain prior authorization.
Private insurers are increasingly focused on denying claims, a trend that has grown post-Affordable Care Act, according to Beatrix Hoffman, author of “Health Care for Some.” Lawsuits have even been filed against UnitedHealth and Humana over alleged misuse of AI tools to deny elderly patient coverage.
The Current State of America’s Health Care System
Our health care system, with increasing private insurance involvement and over half of Medicare beneficiaries enrolled in private plans, is a source of public dissatisfaction. If claims are denied, patients do have the right to appeal with their insurance company or an independent third party.
History of Health Care in America
Despite attempts to implement universal health care systems in the past, such as President Truman’s proposal post-WWII, a variety of health care models have persisted. The American Medical Association wielded significant influence, with concerns over potential corporate and government control of health care. This fear led to the development of the private insurance company model in 1938, which remains in place today.
A Health Care Paradox: High Spending Yet Struggling Citizens
The paradox of America’s health care system is its world-leading expenditures yet the struggle of many citizens to afford necessary care. Universal health care could potentially be a cheaper solution, offering advantages like the ability to negotiate drug prices. A single-payer system could lead to significant savings, according to a study published in The Lancet.
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