Name: The Issues with Health Insurance Companies, Explained by Doctors
Uploaded: 2024-12-13T22:25:00Z
Duration: 5 min 54 s
Description: After the shooting of UnitedHealthcare CEO Brian Thompson in New York City, physicians offer a sober look at frustrations with the healthcare system in the U.S. Photo illustration: WSJ

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After the shooting of UnitedHealthcare CEO Brian Thompson in New York City, physicians offer a sober look at frustrations with the healthcare system in the U.S. Photo illustration: WSJ

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The Issues with Health Insurance Companies, Explained by Doctors

Narrator: After Brian Thompson, the CEO of UnitedHealthcare was killed in New York City, we saw a huge outpouring of anger directed toward Health Insurance companies. The vitriol and the scale of the response was shocking to many. We wanted to hear from doctors who deal with patients and insurers on a day-to-day basis.

Have you been surprised by the response?

I think I have, and I haven't. I mean, I certainly feel the undertones from my patients, the anger at my staff that they can't do something right away, but surprised at the amount of support there is for obviously something that's inappropriate and shouldn't have ever happened.

I'm not surprised to be honest. I'm not always able to give my patients the care they need.

What is the worst thing you have to deal with from an insurance perspective?

The worst thing that we have to deal with from the standpoint of the patients is pre-authorizations.

Prior authorizations means that the insurer has to approve whatever medical procedure that your doctor thinks you need.

Narrator: Nearly all doctors surveyed by the American Medical Association said that prior authorization requirements have delayed access to necessary care.

Something that pretty much didn't even exist when I started practice decades ago.

Instead of us being able to spend time in the office with our patients, we're wasting that time with insurance companies.

Now we have entire teams dedicated just to the nonclinical administrative side of our practice that wasn't there when I started 10 years ago.

Another pain point can come after the care is rendered. Sometimes the care is given and then the insurer decides in retrospect perhaps, that it wasn't justified or it doesn't fit the plan and shouldn't be paid for.

So what we see in healthcare workers is people get demoralized, people leave the business.

It's a huge financial and emotional burden.

Narrator: And it can impact a patient's care. One in four doctors said that prior authorization led to a serious or life-threatening medical issue.

I had a patient, she had a history of breast cancer. She had a double mastectomy. Several years later, she started getting pain in her chest and the appropriate test for her unquestionably was a CT scan. I ordered the test, it was denied by her Health Insurance company. It was a delay until she actually got the test she needed. It showed a recurrence of cancer and the patient later died. This is a stark example, but not an uncommon example of what happens. It's not always a discussion just between me and the patient as it should be. It's an insurance company getting involved and deciding that the care that I think is necessary, the care that the patient thinks is necessary, is not necessary.

Is there a specific point you can trace back to when things started getting worse?

Certainly the expansion of Medicare Advantage has made a massive difference for us.

Narrator: Medicare Advantage when private companies administer publicly funded insurance has expanded widely. More than half of all eligible people now have one of these private plans.

With traditional Medicare, there's essentially no prior authorization, when Medicare Advantage takes over, now we introduce significant prior authorizations.

These private for-profit insurers that run Medicare Advantage, they're absolutely in a league by themselves, and the denials are, to my mind completely capricious.

Narrator: Data shows that Medicare Advantage insurers denied about 7% of prior authorization requests. According to a 2024 Senate report, denial rates were much higher when it came to things like rehab and post-op care. The Wall Street Journal has been investigating Medicare Advantage for the last year.

This year, the Journal has actually spent a lot of time looking at things that really aren't part of the front door that are kind of behind the scenes. One of our stories looked at the prevalence of diagnoses in Medicare Advantage that did not actually come from a doctor treating the patient. They actually were added to the patient's records through activities associated with the insurer. So to understand Medicare Advantage, one thing you have to understand is that the insurers that work in Medicare Advantage are paid more if the person that they're covering has more health conditions. So there's a strong incentive for Medicare Advantage insurers to document more diagnoses, things like diabetic cataracts or morbid obesity. It doesn't mean those diagnoses aren't true, but there is a greater payment for the insurer if they document more diagnoses. Insurer driven diagnoses in 2021 generated $8.7 billion in payments for UnitedHealthcare, and that was the most in that year of any insurer.

Narrator: In response to the journal's previous reporting, UnitedHealth has said that Medicare Advantage provides better health outcomes and more of affordable healthcare for millions of seniors. When reached again for comment, they pointed us to recent changes the company has made to streamline the prior authorization process. America's Health Insurance plans and Industry Trade Group said in a statement to the Journal that providers and drug makers also share in the responsibility to patients and that health plans work to protect patients from rising costs.

So I think insurers are, do see themselves, and it is true as one of the few players in the system whose job is to try to tamp down those costs. However, the costs continue to rise.

I think it's important that there are checks and balances. The real problem is that what was intended to be a nice check and balance has turned into a way of penalizing physicians and patients in order to increase profits for shareholders.

The universal feeling is that insurance companies are working against us, against what we want for our patients, what our patients need.

The Issues With Health Insurance Companies, Explained by Doctors

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