Weird health insurance denials encourage out-of-pocket

The Washington Post reports "denials of health-insurance claims are rising — and getting weirder". They go on:

[health insurance] companies appear increasingly likely to employ computer algorithms or people with little relevant experience to issue rapid-fire denials of claims — sometimes bundles at a time — without even reviewing the patient’s medical chart ... It’s a handy way for insurers to keep revenue high ...

A recent study by the Kaiser Family Foundation (KFF) of plans on the Affordable Care Act marketplace found that even when patients received care from in-network physicians — doctors and hospitals approved by these same insurers — the companies in 2021 nonetheless denied, on average, 17 percent of claims. One insurer denied 49 percent of claims in 2021; another’s turndowns hit an astonishing 80 percent in 2020.

How will rising denials affect the healthcare system?

The more claims health insurance companies deny arbitrarily, the more we will see the following.

• Healthcare providers will be less likely to accept insurance. Instead, they will encourage patients to pay out of pocket.
• Patients will be less likely to use health insurance, because it can so easily lead to paperwork nightmares, and because their healthcare providers are encouraging them to pay out of pocket. Plus, for patients who are members of Pocketero, paying out of pocket gets the best price.

Health insurers were already incredibly difficult to work with because of arcane billing requirements and unreasonable denials. As they become increasingly impossible, the market will have no choice but to revert back to the way it used to be. As recently as the 1960s, "Americans used to pay for things like medicine almost entirely out-of-pocket". The challenge will be paying today's prevailing prices for healthcare, which are much higher than the 1960s. That's why Pocketero is such an important tool in a healthcare economy where health insurance companies are largely unusable.