Insurance companies sure found plenty of creative ways to make money in 2021. Some we expected, some were new, and many made it harder for patients to access the healthcare services they need.
As we tracked insurance lawsuits, investigations, and headlines, we found a couple recurring themes. Here are three of the worst insurance trends of the year:
Pandemic Underpayments
As the country battled a second, even more deadly year of the COVID-19 pandemic, we’d love to say that every stakeholder across the healthcare industry banded together to make sure patients had easy access to tests, vaccines, and medical care. Alas, we cannot.
First UnitedHealthcare was accused of shortchanging pediatricians on vaccine and COVID-19 tests. Later, Anthem caught California’s attention for the same behavior. Then, residents across New York state received surprise medical bills for their COVID-19 test – upwards of a few hundred dollars. By October 1, just as cases were surging, insurers in Michigan were sunsetting COVID-19 cost waivers.
These, and other similar policies benefit absolutely no one – except shareholders. Is it any wonder that we look poised for another long, pandemic winter?
Managed Care Mischief
Managed Care Organizations (MCOs) just couldn’t get it together this year. In case you need a refresher, these are the insurance companies that contract with government agencies to manage the care that Medicare and Medicaid members receive.
The argument is, ostensibly, these big companies are more efficient than the government is in managing all those medical claims. Sure.
So explain why Centene, one of the biggest MCOs in the country, had to set aside $1 billion (with a B) to settle overbilling suits and other investigations in at least six states?
Oh, and then an exclusive report in the Wall Street Journal found that Medicare insurers drew $9.2 billion in federal payments in one year through controversial billing practices. Where are those efficiencies, again?
Network Disruption
Insurers aggressively wielding power in network negotiations isn’t unique to 2021 – we’ve been following this trend for years. But it remains one of the core tactics payors have for determining when, where and how patients get the medical care they need.
We tracked a number of these cases this year – from the Southeast to the Big Apple, from Texas to California. It’s clear that tensions between payors and providers are growing – and even Kaiser Health News found that more reimbursement contract disputes are ending without a deal.
And who gets stuck in the middle when payors won’t, well, pay? Patients, of course.
The fact is, business practices like these three trends benefit shareholders, at patients’ expense. In the new year, we’ll continue to uncover how insurance companies are covering less and charging more, driving down healthcare quality and driving up healthcare costs. Stay tuned.
