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Everyone blames the life insurance company for being greedy for the denial of increasing complaints and roadblocks to be observed. It's stupid. Follow the money to find the real culprits: the lying politicians.
In 2013, before the Affordable Care Act regulations began, insurers denied about 1.5% of claims, according to the American Medical Association. But under the ACA rules, denials have increased tenfold. Now about 15% of claims are rejected, reports Premier, an insurance consulting firm. Some insurers deny a third or more of claims, according to Kaiser Family Foundation research.
Insurers also require prior authorization for many types of treatments and medications, tying your doctor's hands and delaying your care at risk.
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Your doctor must call the insurer before starting treatment or prescribing medication. Rarely is the person on the other end of the phone an expert on the disease or treatment in question. It may be an OB-GYN that overrides what your neurosurgeon recommends, warns the AMA.
Anger against health insurance companies is misplaced. People should hold politicians responsible for the problems they have caused. (iStock)
Dr. Debra Patt prescribed a combination of drugs to a patient suffering from metastatic breast cancer but had to wait weeks before receiving approval. In the meantime, reports the AMA, he had to accept regular chemotherapy, without help: His patient died.
“You have health plan representatives who have never met a patient, never been at the bedside or administered the medication but now they are making treatment decisions,” said Tina Grant, senior vice president of public policy and advocacy at Trinity Health, administration 92. Catholic Hospitals.
To follow House Committee on Energy and Commerce evidence, 80% of the initial approvals that Cigna denied for Medicare Advantage customers were overturned on appeal, a sign that proper care was being denied. Cigna uses an algorithm called PxDx to deny pre-authorization in bulk.
Refusals and prior authorization requirements increased after the ACA went into effect. But don't blame it on increasing profits. The ACA regulates enrollment rates, and if rates go up, insurers must send discounts to consumers.
Giants like United Healthcare have become behemoths that make money by buying physician practices, hospitals and drug chains, not by selling health plans, according to industry research by IBISWorld.
The reason why health insurance is becoming unreliable is that politicians support Obamacare they deliberately made a promise that was impossible to fulfill without the insurers using fraudulent methods.
Obamacare advocates have promised everyone that they will be charged the same regardless of their “pre-existing conditions.”
The numbers don't work. Each year, 5% of the population spends more than 50% of health care. That is the natural truth, politics aside.
Politicians, like President Barack Obama, pushed Obamacare knowing it would be tough for insurance companies. FILE: Obama celebrates after accepting his party's nomination during the Democratic National Convention in Charlotte, North Carolina on Thursday, September 06, 2012. (Photo by Christopher Evans/MediaNews Group/Boston Herald via Getty Images)
Telling insurance brokers to pay 5% of the same price they charge healthy people is like giving groceries every month to a skinny fashion model and the winner of the Nathan's Hot Dog Eating Contest for the same price . Funny.
Five percent of people paying additional premiums and 50% of additional medical needs.
The federal government should have stepped in with additional payments to cover people with pre-existing conditions. Instead, insurers were hit with a flood of new claims and told to work on it. They used Draconian methods to cut costs.
The winners? Democratic politicians. Covering pre-existing conditions at no charge is common.
The losers? Everyone has to worry that their next treatment will be delayed or their next application will be denied.
Sadly, the biggest losers are the very sick who suffer the most from the tight control of care, according to a National Bureau of Economic Research paper on Medicaid managed care.
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More than half of the states are now passing laws to limit prior consent.
That is a step in the right direction. But Americans need to reevaluate managed care.
Refusals and prior authorization requirements increased after the ACA went into effect. But don't blame it on increasing profits. The ACA regulates enrollment rates, and if rates go up, insurers must send discounts to consumers.
There is no evidence that it improves health.
President Joe Biden's deputy health policy secretary boasts that the ACA's expansion — particularly in managed care — has reduced “illness and death.” It is an outright lie. Americans are sicker and living shorter lives than they were before the ACA.
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Another way is to allow for low-cost catastrophic insurance, which only comes in for large debts. Healthy people who get coverage at work will benefit from reduced co-insurance and a bigger take-home pay instead of the $25,000 plan — this year's cost of family coverage.
The Democrats are trying to call the dangerous protection as “vacuum insurance.” The Biden administration has made it harder to buy. But Americans are beginning to see that health plans that deny applications and make you wait dangerously long for pre-approval are the real “garbage.”