Valued Voice

STAT News recently published an opinion piece detailing the pressures hospitals are under, from the need for competitive wages to attract and retain talent to the ever-growing inflation rate driving up costs:
 
Adding to this budgetary stranglehold are payment delays and insurance claim denials by payers, which compromise patients’ access to health care and providers’ financial viability.
 
This commentary dives deep into the strain put on hospitals:
 
….nearly 15% of all claims submitted to payers for reimbursement were initially denied. Medicare Advantage and Medicaid managed care plans denied claims at higher-than-average rates of 15.7% and 16.7%, respectively.
 
It addresses the growing number of claims denied:
 
These denials include services that had been preapproved via the prior authorization process, and were more common for treatments costing above $14,000.
 
In addition, it underlines the costly implications for those we aim to serve, our patients:
 
When health plans deny coverage for care, patients may be liable for some or all of the costs, and a lengthy wait for coverage approval may result in patients’ delaying care. Nearly 50% of Americans report skipping or delaying follow-up care because of costs, and the same percentage say they would be unable to pay for an unexpected $1,000 medical bill within 30 days.
 
For more about the impact on hospitals and potential policy solutions, we encourage you to read the full opinion piece by Michael J. Alkire, at STATnews.com.