Penalize Insurance Payers for Overturned Denials and Stop the Denials Crisis
Penalize Insurance Payers for Overturned Denials and Stop the Denials Crisis
The Issue
With the support of healthcare providers around the country, we intend to bring forward proposed legislation entitled the “No Surprise Denials Act” to impose penalties on payers who unfairly and/or inappropriately deny claims.
Health insurance claims denials have become a leading force negatively impacting healthcare providers and their ability to provide world-class care. According to CMS, 30% of claims are denied, lost, or ignored - it's no wonder healthcare providers’ margins are shrinking at a rapid pace. According to research conducted by Change Healthcare, denials represent 90% of missed revenue opportunities.
In addition to lost revenue, the burden to recover improperly denied claims lies almost entirely on providers. Change Healthcare’s research also demonstrated that out of $3 Trillion in claims submitted by hospitals in 2016, $262 Billion was denied. Though 63% of those claims were recoverable, it required $8.6 Billion in administrative costs to do so – with payers facing no penalties for overturned denials. Juxtapose that with the severe fines & penalties associated with overpaid claims that fall squarely on providers and it becomes clear that there is a concerted effort to penalize providers and very little attempt to do the same for payers.
The five (5) largest payers (UHG, Elevance, Aetna, Cigna, and Kaiser) had a combined profit of more than $45 Billion in 2022, while the average hospital struggled to make any profit at all. In fact, according to Definitive Healthcare, the median operating margin for U.S. hospitals in 2021 was -1.5%. That’s right, hospitals are running on negative margins while payers rake in billions.
If we do not fix the denials crisis, healthcare facilities around the nation will continue to fail, negatively impacting our communities and leading to worsened health outcomes.
With the support of healthcare providers around the country, Crossroads Health intends to bring forward proposed legislation entitled the “No Surprise Denials Act” to impose penalties on payers who unfairly and/or inappropriately deny claims.
The time to act is now, sign the petition to support our mission of ending surprise denials from payers.
329
The Issue
With the support of healthcare providers around the country, we intend to bring forward proposed legislation entitled the “No Surprise Denials Act” to impose penalties on payers who unfairly and/or inappropriately deny claims.
Health insurance claims denials have become a leading force negatively impacting healthcare providers and their ability to provide world-class care. According to CMS, 30% of claims are denied, lost, or ignored - it's no wonder healthcare providers’ margins are shrinking at a rapid pace. According to research conducted by Change Healthcare, denials represent 90% of missed revenue opportunities.
In addition to lost revenue, the burden to recover improperly denied claims lies almost entirely on providers. Change Healthcare’s research also demonstrated that out of $3 Trillion in claims submitted by hospitals in 2016, $262 Billion was denied. Though 63% of those claims were recoverable, it required $8.6 Billion in administrative costs to do so – with payers facing no penalties for overturned denials. Juxtapose that with the severe fines & penalties associated with overpaid claims that fall squarely on providers and it becomes clear that there is a concerted effort to penalize providers and very little attempt to do the same for payers.
The five (5) largest payers (UHG, Elevance, Aetna, Cigna, and Kaiser) had a combined profit of more than $45 Billion in 2022, while the average hospital struggled to make any profit at all. In fact, according to Definitive Healthcare, the median operating margin for U.S. hospitals in 2021 was -1.5%. That’s right, hospitals are running on negative margins while payers rake in billions.
If we do not fix the denials crisis, healthcare facilities around the nation will continue to fail, negatively impacting our communities and leading to worsened health outcomes.
With the support of healthcare providers around the country, Crossroads Health intends to bring forward proposed legislation entitled the “No Surprise Denials Act” to impose penalties on payers who unfairly and/or inappropriately deny claims.
The time to act is now, sign the petition to support our mission of ending surprise denials from payers.
329
The Decision Makers
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Petition created on May 15, 2023