This is the title I chose for my personal blog, which is meant to give me an outlet for one of my favorite crafts – writing – plus to use an image from my favorite sport, golf. Out of college, my first job was as a reporter for the Daily Astorian in Astoria, Oregon, and I went on from there to practice writing in all my professional positions, including as press secretary in Washington, D.C. for a Democrat Congressman from Oregon (Les AuCoin), as an Oregon state government manager in Salem and Portland, as press secretary for Oregon’s last Republican governor (Vic Atiyeh), and as a private sector lobbyist. This blog also allows me to link another favorite pastime – politics and the art of developing public policy – to what I write. I could have called this blog “Middle Ground,” for that is what I long for in both politics and golf. The middle ground is often where the best public policy decisions lie. And it is where you want to be on a golf course.
When it comes to insurance – all types of insurance, including health, property, life, auto, etc. – I always have mixed emotions.
On one hand, it makes sense to protect yourself against future costs in all of the insurance policy areas mentioned above.
On the other hand, I often regale one of my friends, now retired, who was an insurance agency manager, with this comment: Insurance companies love when you pay premiums; they hate when you make claims.
I also was a lobbyist for several health insurance companies, so when it comes to the story I cite below, I understand a bit about the reality of health treatments covered by insurance…or not.
Written by Elisabeth Rosenthal, a senior contributing editor at Kaiser Foundation Health News, a story on this subject appeared under this headline: Denials of health-insurance claims are rising — and getting weirder.
On to the story:
“Millions of Americans in the past few years have run into this experience: Filing a health-care insurance claim that once might have been paid immediately, but instead is just as quickly denied.
“If the experience and the insurer’s explanation often seem arbitrary and absurd, that might be because companies appear increasingly likely to employ computer algorithms or people with little relevant experience to issue rapid-fire denials of claims — sometimes bundles at a time — without even reviewing the patient’s medical chart. A job title at one company was ‘denial nurse.’
“It’s a handy way for insurers to keep revenue high — and just the sort of thing that provisions of the Affordable Care Act were meant to prevent. Because the law prohibited insurers from deploying a number of previously profit-protecting measures such as refusing to cover patients with pre-existing conditions, the authors worried that insurers would compensate by increasing the number of denials.”
The law assigned the Department of Health and Human Services to monitor denials in plans on the Obamacare marketplace, as well as those offered by employers and insurers. But the agency has not done a good job of meeting that assignment.
A recent study by the Kaiser Family Foundation of plans on the Affordable Care Act marketplace found that, even when patients received care from in-network physicians — doctors and hospitals approved by these same insurers — the companies in 2021 denied, on average, 17 per cent of claims.
One insurer denied 49 per cent of claims in 2021; another’s turndowns hit an astonishing 80 per cent in 2020.
Some denials are, of course, well-considered, and some insurers deny only 2 per cent of claims.
Now, all of this said, my easy answer is this: If an accredited physician says a treatment is necessary, it should be covered by insurance.
Does this put too much faith in physicians? Perhaps.
But better to put faith there than in a bureaucratic on-line decision-maker.
When I lobbied for Oregon health insurers, I made the “trust-the-doctor” point repeatedly, even though I represented the insurance side of the house.
It was a good point then. It is a good point now.
