Denial and frustration about medical costs have fueled its growth. vitriol against health insurance companies in the context of Murder UnitedHealthcare CEO Brian Thompson. Last week, a similar outcry overturned Anthem Blue Cross Blue Shield. The decision Limiting coverage of anesthesia during surgery.
Anger may be rooted in fears that unexpected medical expenses could prove financially devastating, as well as concerns that insurers may deny necessary care, even to those who are in need. Even for those who have health insurance, health and wellness can be at risk.
Some of these concerns are well established: Above Cause of bankruptcy America has health care debt, which underscores the financial pressures that can arise from high medical costs.
In fact, most adults say they worry about their ability to pay for health care services or unexpected medical bills, sentiments shared by people regardless of how financially comfortable they are. Are or are struggling, a KFF Survey Found earlier this year.
KFF data shows that in 2024, the average health insurance premium cost for families was $25,572 per year, while single workers paid an average of $8,951, up 6% and 7% from the year before. represents the The health policy research firm found that since 2000, health insurance premium increases have outpaced inflation in all but a few years.
“Unhappiness with insurance stems from two things: ‘I’m sick and I’m having trouble,’ and the other is the high cost — ‘I’m paying more than I used to, and I’m paying more than I’m worth.’ Up,” said Rob Andrews, CEO of the Health Transformation Alliance, a cooperative that represents major companies like American Express and Coca-Cola that work to improve health insurance for their employees. “A lot of people think they’re getting less from their insurers,” Andrews said.
And while Americans have unhappily faced other forms of inflation in recent years. Skyrocketing grocery prices Thomas pointed out that he has been credited with helping President-elect Donald Trump claim victory last month — health insurance could have even more personal benefits.
“It’s not, ‘How much am I going to pay for a lawn chair or a steak,'” Andrews noted. “People are sick or have some kind of health problem that they’re worried about.”
To be sure, people with employer-sponsored health insurance typically don’t pay full premiums, since their employers pick up most of the tab.
Yet KFF data shows that employees’ share of their premiums is also increasing, with a worker with family coverage paying an average of $5,700 a year in premiums in 2017, the highest for this data. In the most recent year, up from about $1,600 in 2000, KFF data shows the average family deductible — the amount paid out-of-pocket before insurance kicks in — in 2013, according to KFF. Increases from $2,500 to $3,700 in 2023.
About 81 percent of Americans said they were dissatisfied with the cost of health care in the U.S. last year, a 16-year high, according to Gallup polling. found.
“We’ve reached a point where health care is so inaccessible and unaffordable, people are justified in their frustration,” said Dr. Celine Gonder, CBS News medical contributor and publicist at KFF Health News. editor-at-large for Health told CBS. Friday morning.
Denial of health insurance
In addition to rising health insurance costs, Americans are also angry about the denial of coverage, a KFF. Analysis Nongroup qualified health plans accounted for nearly 1 in 5 claims in 2021. However, their study found that denial rates varied considerably by insurer, with some as low as 2% while others were as high as 49%.
“When you’re paying for something, and then they don’t give it to you and they keep raising the price, of course you’re going to be disappointed,” said Holden Karau, a software engineer who created a free service. , noted. Fight health insurance. To help people appeal their refusal.
Krau says she came up with the app, which uses AI to generate appeal letters, after her own and her dog’s experience with insurance. Her pet insurer initially refused to pay for anesthesia for her dog’s root canal, while Karau, who is transgender, said her insurance covered her procedure. Handled many appeals to cover car and surgeries.
More insurance companies are using AI to evaluate claims and issue denials, which is not always clear to consumers. The shift to AI-based assessments has led to lawsuits against insurers, including UnitedHealthcare. Sued last year by the families of two now-deceased consumers who alleged that the insurer intentionally used a flawed algorithm to exclude elderly patients from coverage for extended care deemed necessary by their doctors; can be denied.
“With AI tools on the insurance side, there are very few negative consequences to denying their procedures,” Krau added. “We’re seeing a very high denial rate because of AI. And on the patient and provider side, they don’t have the tools to fight back.”
Karau noted that most people may not be aware that they have the right to appeal a denial. The majority of people who experience denials or billing errors don’t fight, a study found found earlier this year. For those who do, the first appeal will be dealt with by the insurer, but if that in-house appeal is also rejected, you have the right to ask an independent assessor to look at your claim. According to To the National Association of Insurance Commissioners.
“There are multiple levels of appeal, and in my experience, I would say it’s important to appeal until you get to at least an independent reviewer,” Carao said. “If you don’t appeal, you won’t get the care you need.”