Almost 60 percent of covered individuals have struggled with their plans in the last year.
A nationwide survey has revealed that almost 60 percent of Americans with health insurance have experienced a problem with their plan within the last year.
The research conducted an evaluation of healthcare coverage among adult Americans with plans.
Among the problems health insurance customers have faced within the last year have included challenges in finding an in-network provider, denied claims, and denied or delayed care that required an insurer’s prior authorization. According to the researchers that conducted the study, these types of challenges to those covered by a plan can lead to delayed treatment or patients choosing not to seek care at all.
“This is more than a mere annoyance. This really does have can have profound implications financially and to health,” explained Kaiser Family Foundation Vice President Kaye Pestaina.
The Kaiser Family Foundation is a nonprofit organization with a focus on healthcare policy. In its most recent report, it determined that coverage challenges are more common among patients who have the highest need for healthcare. For instance, about two of every three survey respondents who rated their health as “fair” or “poor” said that they had experienced a problem with their coverage within the last year. Over 70 percent of people who have undergone mental health treatment have also faced that type of coverage challenge.
Health insurance problems appear to be the most dramatic among people who need to use coverage most.
According to Pestania, there is substantial confusion when covered individuals seek to address their coverage challenges.
“One of the surprises was how many problems go unresolved,” said Pestania. “A large percentage of people who say I either gave up trying to figure out what the answer was, or I never even followed up.”
This appeared to be the case among many types of plans, including Medicaid and Medicare, plans purchased through the Affordable Care Act marketplaces, and those obtained through employers.
“A little more information can go a long way around what’s covered and not covered around what the cost of a particular procedure is before you get it,” added Pestania.
