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It's bad to get the coronavirus, and bad to have to be hospitalized for it. But it's also bad to have to stay in your hospital bed waiting for your insurer to clear you to leave once you've recovered.
But according to a Guardian report, that's what's happening in the U.S. to many privately insured patients who are stuck in limbo as their insurers lag in providing authorization for whatever comes next in their care—whether release or a move to a rehab facility.
Inefficiencies in the prior authorization system, says the report, are "expected" at American hospitals, but with Covid-19 patients flooding available facilities, it can actually turn deadly as beds aren't promptly freed up to be reoccupied.
"Any sort of slowing in the health system has dire consequences," Yale resident physician Augie Lindmark is quoted saying in the report. And with many private insurers not using telemedicine—which could speed the process of treating those who don't require in-person care—because they don't have to, the system is grinding to a halt in some places.
"The federal government never aligned incentives, most states never passed meaningful legislation, and many commercial payers didn't pay health systems for telemedicine," Dr Judd Hollander, an emergency medicine physician and associate dean at Thomas Jefferson University in Philadelphia, is quoted saying, adding, "So now we're left in this horrible scenario." Hollander, according to the report, "has been instrumental in implementing Jefferson's telemedicine program."
Not only are there obstacles to using telehealth in many cases, there are questions about who will get paid and how much—not to mention the issues of older patients being unable to use the technology and doctors new to the system trying to implement it for the first time.
And even though many insurers have "dropped the prior authorization restrictions, the clinic still has to navigate new billing codes and financial loss," says the report, citing Riddhi Shah, director of operations at a mental health clinic in Michigan, also pointing out that insurers can be difficult to reach during the pandemic.
Insurers, for their part, say they're adapting – a Humana spokesperson cited in the report said that the company is not charging for Covid-19 testing and a representative of the Association of Health Insurance Plans called attention to a letter signed by various private payers about their commitment to fighting the virus.
But according to Karen Pollitz, a senior fellow at The Kaiser Family Foundation, that's because the federal government is requiring plans to cover all visits, whether virtual or in person, that are related to testing.
And it's not as if they're not charging at all for Covid-19 care – AHIP verified that out-of-pocket expenses for the treatment would not be waived, and could cost patients thousands of dollars. Just for pneumonia, the report adds, an analysis by the Kaiser Family Foundation found that the cost averaged $20,000 in 2018.
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Marlene Satter
Marlene Y. Satter has worked in and written about the financial industry for decades.
