Rosemead Reader_7/3/2023

Arcadia student sets sights on Stanford, bioengineering after PPE project

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09, 2023 NO. 127

How often do health insurers say no to patients? No one knows.

By Robin Fields, ProPublica

Series: Uncovered

How the Insurance IndustryDenies Coverage to Patients

It’s one of the most crucial questions people have when deciding which health plan to choose: If my doctor orders a test or treatment, will my insurer refuse to pay for it?

After all, an insurance company that routinely rejects recommended care could damage both your health and your finances. The question becomes ever more pressing as many working Americans see their premiums rise as their benefits shrink.

Yet, how often insurance companies say no is a closely held secret. There’s nowhere that a consumer or an employer can go to look up all insurers’ denial rates — let alone whether a particular company is likely to decline to pay for procedures or drugs that its plans appear to cover.

The lack of transparency is especially galling because state and federal regulators have the power to fix it, but haven’t.

ProPublica,in collaboration with The Capitol Forum, has been examining the hidden world of insurance denials. A previous story detailed how one of the nation’s largest insurers flagged expensive claims for special scrutiny; a second story showed how a different top insurer used a computer program to bulk-deny claims for some common procedures with

little or no review.

The findings revealed how little consumers know about the way their claims are reviewed — and denied — by the insurers they pay to cover their medical costs.

When ProPublica set out to find information on insurers’ denial rates, we hit a confounding series of roadblocks.

In 2010, federal regulators were granted expansive authority through the Affordable Care Act to require that insurers provide information on their denials. This data could have meant a sea change in transparency for consumers. But more than a decade later, the federal government has collected only a fraction of what it’s entitled to. And what information it has released, experts say, is so crude, inconsistent and confusing that it’s essentially meaningless.

The national group for state insurance commissioners gathers a more detailed, reliable trove of information. Yet, even though commissioners’ primary duty is to protect consumers, they withhold nearly all of these details from the public. ProPublica requested the data from every state’s insurance department, but none provided it.

Two states collect their own information on denials and make it public, but their data covers only a tiny subset of health plans serving a small number of people.

The minuscule amount of details available about denials robs consumers of a vital tool for comparing health plans.

“This is life and death for people: If your insurance won’t cover the care you need, you could die,” said Karen Pollitz, a senior

fellow at KFF (formerly known as the Kaiser Family Foundation) who has written repeatedly about the issue. “It’s all knowable. It’s known to the insurers, but it is not known to us.”

The main trade groups for health insurance companies, AHIP (formerly known as America’s Health Insurance Plans) and the Blue Cross Blue Shield Association, say the industry supports transparency and complies with government disclosure requirements. Yet the groups have often argued against expanding this reporting, saying the burdens it would impose on insurance companies would outweigh the benefits for consumers.

“Denial rates are not directly comparable from one health plan to another and could lead consumers to

By Jose Herrera, City News Service

Despite major investments in housing and intervention programs, the number of people experiencing homelessness in the Los Angeles area continues to climb, with results of the most recent count released Thursday showing a 9% year-over-year increase in homelessness in the county, and a 10% jump in the city.

According to the results of the point-in-time count conducted in January, there were 75,518 people experiencing homelessness in the county, and 46,260 in the city of Los Angeles.

That’s up from 69,144 in the county last year, and 41,980 in the city.

The figures continue a steady climb in the number of Southland homeless people over the last five years. In 2018, there were 52,765 homeless counted in the county, and 31,285 in the city.

“These results are disappointing,” Los Angeles County Board of Supervisors Chair Janice Hahn said in a statement. “It is frustrating to have more people fall into homelessness even as we are investing hundreds of millions of taxpayer dollars and resources into efforts to bring people inside. I appreciate the cities that have stepped up and supported solutions, but these numbers prove that solutions-oriented cities are too few and far between.

“I hold out hope that the new partnership between the county and city of Los Angeles will make a difference and help us more effectively address this crisis. 2023 needs to be a watershed year for us where we turn these trends around.”

The Los Angeles Homeless Services Authority, a joint powers authority coordinated by both the city and county of Los Angeles, coordinated the count, which was conducted between Jan. 24-26 across the county.

Volunteers worked in groups of four to count the number of unsheltered individuals, tents, vehicles and makeshift shelters in their census tract.

In a press conference Thursday morning, CEO of LAHSA Va Lecia Adams Kellum stated the homeless count results “tell us what we already know — that we have a crisis on our streets, and it’s getting worse.”

“The important thing to take away from today is that for the first time, the city, county and LAHSA are moving with urgency to house the people living in our streets,” she added.

The rise in the county’s homeless population coincides with increases in major cities across the United States, officials said.

Chicago and Portland saw double-digit increases of 57% and 20%. Several Southern California counties experienced increases larger than Los Angeles, including San Bernadino, 26%; San Diego, 22%; Kern, 22%; and Riverside, 12%.

The number of unhoused people in interim housing held steady at 20,363 — the rise in the number of people experiencing unsheltered homelessness coincided with the overall increase in the point-in-time count.

According to the data, Black people experience homelessness at a rate far greater than their prevalence

A picture of a piggy bank, a stethoscope and a stack of US $1 bills.| Photo by 401(K) 2012 (CC BY-SA 2.0)

Homeless numbers continue to climb, despite rising funding