U.S. patients face problems with health care, insurance

Possibly one of the most important benefits assigned to employees is their health benefits. People expect coverage for a multitude of issues but increasingly, are finding problems with their experiences.

Most (58%) people with health insurance say they encountered at least one problem using their coverage in the past year, with even larger shares of people with the greatest health care needs reporting such problems, finds a new KFF survey of consumer experiences with health insurance.

At least half within each of four major types of health coverage – employer, Medicaid, the Affordable Care Act’s marketplace, and Medicare – say they had a problem using their coverage in the past year.

“The survey shows that the sheer complexity of insurance is as big a problem as affordability, particularly for those with the greatest needs,” KFF President and CEO Drew Altman said. “People report an obstacle course of claims denials, limited in-network providers, and a labyrinth of red tape, with many saying it prevented them from getting needed care.”

Such problems are more common among people with greater health care needs. For example:

• Two-thirds (67%) of consumers who rate their own health as “fair” or “poor” encountered a problem in the past year.
• About three-quarters (74%) of those who received mental health treatment in the past year reported a problem.
• More than three-quarters (78%) of those who received a lot of health care (more than 10 provider visits in the past year) reported a problem.

However, it’s not all bad news. The survey also showed that among those who reported recent insurance problems, half say they were able to resolve the issue to their satisfaction. Still, nearly as many say either that the issue had been resolved in a way they didn’t like (28%) or that it remained unresolved (19%). Most insured adults (60%) do not know they have appeal rights by law, and three quarters (76%) do not know what government agency to call for help dealing with their insurance.

The report also probes the challenges facing insured people who rate their mental health as fair or poor, regardless of whether they sought or obtained mental health treatment. This includes about 1 in 5 of all people with insurance, and 1 in 3 of those with Medicaid coverage.

Substantial shares of enrollees in this group rate the availability (45%) and quality (37%) of mental health therapists and providers covered by their insurance as “fair” or “poor.”

Among those who say their own mental health is fair or poor, 43% say that there was a time in the past year when they did not get needed mental health care. Among young adults under age 30 who describe their mental health as fair or poor, more than half (55%) say they did not get needed mental health care in the past year.

Related: How employers can lessen the impact of delayed medical care

People cite various reasons for not getting needed mental health care, but insurance was a factor for many. Among all insured adults who didn’t get needed mental health care, more than 4 in 10 (44%) say they couldn’t afford the cost, and more than a third say it was because their insurance wouldn’t cover it.