WASHINGTON, D.C. — Nearly 60 percent of people with health insurance have had trouble using their plans in the past year, according to a nationwide survey evaluating healthcare coverage.
These insurance problems include denied claims, difficulty trying to find an in-network provider and delays and denials of care that involved an insurer’s previous authorization. Researchers said this could result in delayed treatment or not getting care at all.
“This is more than a mere annoyance. This really does and can have profound implications financially and to health,” said Kaye Pestaina, Vice President at KFF.
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This latest report is from KFF, a nonprofit organization that focuses on health policy.
It finds insurance problems are more common for patients with significant healthcare needs. For example, about two-thirds who consider their health as “fair”, or “poor” reported a problem in the past year. It also shows more than 70 percent of those who receive mental health treatment experience troubles too.
Pestania said there’s a lot of confusion when people try to address these troubles.
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“One of the surprises was how many problems go unresolved,” she said. “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 isn’t limited to one type of insurance. Researchers evaluated plans from employers, the Affordable Care Act’s marketplace, Medicaid and Medicare.
They believe simplifying policies would help.
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“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,” said Pestania.
Doctors say it’s also important for people to know their rights like your ability to appeal a denied claim.
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