AHA head: ‘Time to hold commercial health insurers accountable’

The problem of commercial health insurers standing between patients and providers is bad and only getting worse.

That’s the view of Rick Pollack, president and CEO of the American Hospital Association.

In commentary published this week in U.S. News & World Report, Pollack lets the numbers make his case.

Some 95% of hospitals say staff time completing prior authorization requests and logging denial appeals is increasing, he writes, citing a 2022 American Medical Association survey. “Much of this effort is spent challenging flawed insurer analysis, as most denials that are appealed are ultimately overturned,” Pollack remarks.

More stats from the piece:

• 80% of physicians express frustration over care impediments caused by health insurance policies, according to AHA’s own surveying.
• 62% of 1,500 surveyed patients say their treatment hit a snag set by their insurance carrier.
• 54% of patients are having a hard time affording their health coverage at a time when commercial insurers are earning “record-high profits,” Pollack emphasizes.
• 50% of hospitals have not been paid for claims totaling $100 million or more for more than six months—and 7 in 10 hospitals are still dealing with outstanding claims from 2016 or earlier.

Pollack also describes several anecdotes in which patients suffered due to serpentine prior authorization practices, stringent claims review processes, uncaring attitudes and other avoidable harms.

“Clinicians should be able to focus their time on providing care instead of going through costly bureaucratic hurdles,” Pollack writes. “It is time to hold the commercial health insurers accountable and put patients first.”

Read the whole thing.