ERin Massi is busy in her daily function as a scientist at the Biotechnology Company. But recently, she had another job, too: trying to persuade her insurance company, CIGNA, to pay the price of a drug you need to insomnia.
Premera, former Massey, has covered with another employer, the medicine, and the doctor considered this medically necessary and has filled many forms that say that. But Cigna has repeatedly rejected her requests to the insurance company to cover the drug, she says.
Massi is estimated that she spends 8 to 10 hours a week working to cover the drug: talk to CIGNA representatives, fill out forms, write calls, and search for how to persuade Cigna that the drug is necessary for its health. Its experience is not unusual: in total, Americans spend at least 12 million hours a week in contact with the health insurance company, according to Gallup survey.
They do this because of the complex nature of the American health care system, which often requires the cost of procedures-a green light from the insurance company, which is the procedure necessary medically and covered with insurance-it ends repeatedly with the denial of care. About 45 % of adults of the insured work age received a medical bill or fees were imposed on a service last year. They believed that it should have been free or covered with insurance, according to 2024. Study of the Commonwealth Fund. And 17 % of adults, such as Massi, denied the coverage of the care recommended by the doctor.
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As a result, people must capture the phone and argue with their insurance companies, write the appeal letters, and spend countless hours to track their claim. This time it is absorbed, called “”Time tax“By Atlantic Ocean Journalist Annie Lauredi, and The bureaucracy “sludge” Written by Stanford Professor Jeffrey Balvir, is a bad for the economy in general and bad for our health.
We may now spend more time in this sludge than in the past. News stories It indicates that insurance companies “are increasingly ingenious” in the use of technology to deny the payment of claims. Commonwealth study. “It is really frustrated for people to pay their installments and then not to get the care they need when they need it,” she says. This undermines people’s confidence in the health care system and makes them less likely to search for medical care, she says.
One study published in Jama open network I found that 22 % of cancer patients did not obtain the care described by their doctors due to the delay in prior mandate and other administrative issues.
Cigna Time told that she was unable to comment on the case of any member without giving up HIPAA. But Massi said that after time she called CIGNA about her case, she received an email stating that the original decision that she refused was her medicine was turned and also that Cigna informed her doctor that she would cover the medicine. “We don’t want anyone to spend hours on the phone that understands its benefits or solving problems” and that he recently launched an initiative designed to simplify its operations.
The presence of an insurance company contrary to the member’s refusal after the media or the attention of social media is Documented. Not everyone can rely on the reporter’s inquiries to cancel their insurance refusal.
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This health care time tax also costs a lot of money in lost productivity. PFEFFer, from Stanford, estimates that the cost of the time spent by employees who deal with their health insurance companies About 21.57 billion dollars every year. They often spend time, they will work in dealing with their insurance companies – often because the only time through which they can speak to claim officials is during normal working hours.
Since health insurance is often a benefit that employers run, employees sometimes become more frustrated with their company when their insurance does not work as it should. PFEFFer says that people who spend longer on the phone with their health insurance company are likely to be less satisfied than their current workplace, and they are more likely to have missed one or more of the work, and they are more likely to feel combustion at work more than people who do not face insurance problems. The cost of low satisfaction from its productivity is present 95.6 billion dollarsHe says.
Despite the high cost of health insurance time, there are few solutions in the pipeline. The Law of Surprises, which came into effect on January 1, 2022, aims to reduce the time for patients who spend them on the phone with health insurance companies by protecting them from bills to obtain costs outside the network in the event of an emergency. The sponsorship law at reasonable prices contains some guidelines about what insurance companies should cover.
But there are a few national rules that govern the insurance companies ’response times or even require them to show the number of times they deny the claims or wrong paper works.
PFEFFer says it is time for employers to start being more active and accountable for insurance companies about wasting the time of their employees. They employ insurance companies, after all, to provide interest to their employees, but the benefit is not always very useful for the employee. Once employers start forcing insurance companies to show their claim rates or the number of times their decisions are resumed, insurance companies may begin to act better.
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He says: “The employer rents your insurance company, and therefore the employer must say to the insurance company,” We will keep you on a set of performance standards. “If you do not meet our performance criteria, we will shoot you.”
Irene Massi has a course in how to deal with insurance companies; She learned not to allow actors to cut a call until her questions are answered, for example, and demanded everything my written.
She was looking for a treatment for eight years, as she made a lot of experience and error with doctors until she finally landed on the appropriate medicine, so it was especially frustrated that Cigna denied this over and over again.
Until Cigna suddenly reflected the path, her next step was to make an external appeal so that doctors can review her case. At that time, I believed that her insurance company may not have expected her to reach this extent. A few hundred hours ago, you didn’t expect it to reach this extent.
“I only spent full days trying to find out the next step,” she says. “It was a lot of work.”
