Administrative Policies Are Overburdening Providers


Some commercial health insurers are using policies that can delay patient care and create burden for providers, causing relationships with hospitals to worsen, according to a survey by AHA.

The association fielded responses from more than 200 hospitals in 2019 and from 772 hospitals between December 2021 and February 2022, creating data that both predates COVID-19 and represents the lasting effects of the pandemic.

With hospitals strained by the challenges of the labor shortage, the survey highlights how insurer tactics are stretching providers even thinner through administrative tasks.

Of the hospitals and health systems surveyed, 95% said there have been increases in staff time spent seeking prior authorization approval, while 84% reported the cost of complying with insurer policies is increasing.

The time and energy spent by providers is unnecessary, however, as 62% of prior authorization denials and 50% of initial claims denials that are appealed are ultimately overturned.

The result is deteriorating relationships with payers, as 78% of hospitals and health systems said their experience with insurers is worsening. Less than 1% said it was getting better.

“These survey results are stark evidence that some commercial health insurers deny care while hospitals and health systems focus on providing care,” said AHA president. “Patients deserve comprehensive health coverage with the protections they were promised when they signed up. Congress and the Administration need to act now to hold commercial insurers accountable for actions that delay patient care, contribute to clinician burnout and workforce shortages, and increase costs.”

Medicare Advantage (MA) has especially come under scrutiny for often unnecessarily denying or delaying care. AHA pointed to a report by the Office of Inspector General from April who found that 13% of MA prior authorization denials met Medicare coverage rules and 18% of MA payment denials met Medicare coverage and Medicare Advantage organization billing rules.

To push for fairer coverage for both patients and providers, AHA wrote a letter to HHS secretary and Department of Labor secretary asking for more oversight of insurers

For More Information: