Too many Americans with insurance are being denied coverage

healthcare emergency room
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healthcare emergency room

While the debate over healthcare reform has focused on getting more Americans covered by health insurance, Americans who already pay for insurance have been facing their own crisis. According to a recent consumer survey, the health of as many as 53 million insured Americans may be in jeopardy from insurance companies that refuse to cover treatments for chronic or persistent illnesses.

Despite the fact that healthcare now represents more than one-sixth of our economy, the U.S. government has not fully documented the quality of American health insurance. Until the Government Accounting Office (GAO) issued a report in 2011, there were no official or comprehensive statistics on how often insurers denied coverage for prescribed treatments. The GAO’s study, which reviewed data on insurers in six states, found that the rate of coverage denial varied significantly across insurance providers, from 6 to 40 percent. Whether these numbers still hold is anyone’s guess, since the GAO has yet to update the numbers. 

{mosads}Since 2008, the American Medical Association has occasionally published report cards on the nation’s largest insurers, comparing (among other things) their rates of claim denials. But the association’s analysis looks at the percentage of total itemized lines in all filed claims that are denied or reduced to zero dollars. It does not evaluate the types of claims denied.


In March, the Doctor-Patient Rights Project, a new coalition of doctors, patients and healthcare advocates cautioning the dangers of corporate interference in medical decisions commissioned a nationwide survey of insured Americans that I ran. The data showed an alarmingly high rate of denial — 24 percent, nearly one in four — among consumers treating chronic or persistent illnesses. Additionally, in 70 percent of those cases, the denied treatment was for an illness or condition described as “serious.” Up to 43 percent of the individuals denied care described themselves as “in poor health.”

Most consumers reported waiting more than a month to even hear whether their claim was denied or not, and nearly a third, 29 percent, said their condition worsened while they waited for a decision. More than a third, 34 percent, had to put off or forgo treatment entirely because their insurance provider refused to pay for it.

Even when insurance companies eventually approved treatment, the authorization process itself delayed effective treatment for months for many consumers. The burdensome paperwork also contributes to an estimated $471 billion annually in billing and insurance-related administrative costs, regardless of the final outcome.

In the current debate over how best to reform American healthcare, lawmakers have mistakenly set the goal posts where health insurance begins. The Doctor-Patient Rights Project poll reveals that insurance coverage alone is no guarantee that patients will have access to quality healthcare when they most need it. For consumers suffering from chronic or persistent illnesses or conditions, purchasing health insurance means playing a game of chance, where one-in-four will be denied the prescribed treatment for a serious condition.

Consumers who buy health insurance are purchasing peace of mind. They are paying to escape the worry that a single health issue will render them bankrupt. The project’s survey results are a stark reminder that, for those whom arguably need peace of mind the most, purchasing health insurance can raise more anxiety than it alleviates.

While illuminating, polling data is not exhaustive and certainly cannot make up for the lack of official statistics on the number and types of claims being denied by insurance companies. If Congress intends to have an informed debate on healthcare, the U.S. government must commit to reporting regular and rigorous data on insurance company coverage denials.

Without addressing the ability of insured Americans to access the healthcare they pay for, healthcare reform will amount to little more than arranging deck chairs on the Titanic. 

Douglas E. Schoen served as a pollster for President Bill Clinton. A longtime political consultant and pollster, he is also a Fox News contributor and the author of 11 books. Follow him on Twitter @DouglasESchoen

The views expressed by contributors are their own and are not the views of The Hill.

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