As residents of Philadelphia, the Pennsylvania suburbs, South Jersey, and Delaware navigate the complex world of healthcare, many are faced with unexpected medical bills and insurance denials. Despite laws in place to protect patients and ensure access to affordable healthcare services, a new national survey report by the Commonwealth Fund reveals that fewer than half of those who experience these issues actually take action to challenge them.
One of the main reasons for this lack of action is a lack of awareness of their rights. According to Sara Collins, vice president of Health Care Coverage and Access at the Commonwealth Fund, consumers need more information about what they are entitled to under their insurance policies. This is especially true for younger individuals and those with low to moderate incomes, who are more likely to be unaware of their rights.
The report also highlights disparities by race and ethnicity, with Hispanic residents being more likely to not know their rights compared to Black and white residents. This lack of awareness can have serious consequences, leading to financial burdens and barriers to accessing necessary healthcare services.
In response to these challenges, states like Pennsylvania have implemented programs to help individuals challenge insurance denials and billing issues. The state’s Insurance Department launched the Independent Review Program in January, which assigns eligible patient cases to teams of experts who determine if an insurance denial was issued correctly. In the program’s first six months, 194 decisions were made, with over half of the original denials being overturned and coverage being applied.
Insurance Commissioner Michael Humphreys emphasizes the importance of challenging insurer denials through internal or independent external review processes. The data from the Independent Review Program clearly shows that insurers can do a better job of reviewing requests for services and ensuring that patients receive the coverage they are entitled to.
Overall, the findings of the Commonwealth Fund’s survey underscore the need for increased awareness and education around patients‘ rights in challenging medical bills and insurance denials. By empowering individuals with the knowledge and resources to advocate for themselves, we can work towards a healthcare system that is fair, transparent, and accessible to all.