A significant portion of insured, working-age Americans are grappling with unexpected medical bills and insurance coverage denials, which can lead to financial strain and delayed healthcare, according to the results of a survey conducted by The Commonwealth Fund.
Key Takeaways:
- 45% of insured, working-age adults received unexpected medical bills or copayments in the past year.
- 17% of respondents faced coverage denials for doctor-recommended care.
- Significant numbers of people are unaware of their right to challenge billing errors and coverage denials.
- Nearly two of five adults who challenged billing errors or coverage denials saw favorable outcomes.
The Big Picture: High deductibles and copayments are causing nearly two out of five working-age adults to delay visiting the doctor or filling prescriptions. Even those who do seek care can become burdened by medical or dental debt, with almost one-third of working-age adults reporting such experiences.
- Billing Errors: Nearly half of respondents who thought they had received a bill in error did not challenge it. The most common reason was a lack of awareness about their right to challenge the bill, particularly among younger people and those with low income.
- Coverage Denials: 17% of respondents faced coverage denials for doctor-recommended care, with more than half not challenging the denial. This often led to significant delays in care, with almost three out of five reporting such delays.
- Successful Challenges: Among those who did challenge their bills or coverage denials, nearly two out of five saw their bills reduced or eliminated, and half of those who appealed coverage denials had some or all of the denied services ultimately approved
What They’re Saying: “When substantial numbers of people with health insurance are facing unexpected bills and having doctor-recommended care denied, our healthcare system is failing patients,” said Sara R. Collins, Commonwealth Fund Senior Scholar and Vice President for Health Care Coverage and Access.
Recommendations: Policymakers and regulators could consider several actions to improve consumer protections and accountability:
- Enhanced Monitoring: The Department of Health and Human Services could better track claims denials in all commercial insurance plans.
- Stronger Accountability: Implementing policies that penalize insurers for wrongful denials or billing errors could help mitigate these issues.
- Consumer Awareness: Promoting awareness about the right to appeal insurance decisions and establishing consumer support systems could simplify the appeals process and empower consumers
