The targeted murder of the United CEO of Unitedhealthcare, Brian Thompson, has become a turning point in the Increasing public frustration with the health insurance industry. People started to share online stories about how insurers refused the cover to them, upsetting their lives.
“In the aftermath of the murder of the CEO of Unitedhealthcare, we saw a national conversation on the obstacles to health insurance, from delays to denials to the general frustrations of patients by everyday Americans from all the political spectrum,” said Miranda Yaver, assistant professor professor of health and management policy at the University of Pittsburgh.
One of these patients is Shelby Kinsey, a 22 -year -old Texas resident who was diagnosed with SLA last year. She fought her insurer, Blue Cross Blue Shield from Texas, to obtain the approval of Qalsody, who, according to her doctors, was the most effective treatment for her SLA form.
“When we were refused for the first time, we were told that it was due to the Blue Cross Blue Shield in Texas, judging Qalsody Medically useless,” said Kinsey. “We ended up calling the decision three times with the help of our medical coordinator at the Baylor College of Medicine.”
“It honestly shocked me how difficult the process was to obtain the approval of a drug retaining life for a disease that does not have many options,” she added.
CNBC contacted Kinsey’s insurance supplier to comment, but Blue Cross Blue Shield from Texas said that he “did not discuss members’ problems with the media”.
Despite many titles and reports Emphasizing an increase in refusal of health insurance complaints, the fragmented nature of the system makes it difficult to count.
“It can be difficult to estimate exactly the number of complaints rejected during a year given by health insurers, because all health insurers do not report these data. But there are some elements that we know”, said Yaver. “The affordable care law has done a few things to try to make this really complex insurance refusal insurance process more transparent.”
She said that when the insurance companies that the affordable care law regulates patients, they must give reason and disclose information on refusal, and there must also be a call process.
“But as it is the story of a lot of American law and politics, a large part of that comes back to the application,” she added.
Using limited data, KFF, a non -profit organization focused on health policy, published a January study showing that 73 million 392 million network complaints were refused in the United States in 2023. In 2021, 48.3 million 291.6 million network complaints were refused.
In particular, most consumers do not use refusals: less than 1% have done so and insurers have confirmed 56% of these calls.
“One thing we have seen in some of the survey works that we have carried out by questioning consumers through different types of insurance is that they simply do not know that they have a right of appeal,” said Declared Kaye Pestaina, Director and Vice-President of the Protection of Patients and Consumer Protection in KFF. “If the calls were used more often, it could work as a check on carriers. But from what we can see now, if little are called, so it does not work like a check.”
Watch the video To explore the increase in refusal of complaints, how Americans can challenge insurance companies and the current state of health care in the United States