A health insurance provider sent a letter to a baby denying insurance coverage because the baby is a drinker. “You are drinking from a bottle,” the letter stated.
The insurance company acknowledged that the infant is in an intensive care unit (ICU) and breathing on his own, but his habit of drinking from a bottle was grounds to deny his health coverage.
In an editorial for the Washington Post, Kaiser Family Foundation senior contributing editor Elizabeth Rosenthal provided examples of real letters to people who had their coverage denied.
Rosenthal published the letter sent to the baby, denying his coverage. “If only the baby could read,” she said.
Rosenthal blamed former President Barack Obama’s Affordable Care Act (aka Obamacare) which makes it easier for insurance companies to deny claims on an automated basis.
“Because the law prohibited insurers from deploying a number of previously profit-protecting measures such as refusing to cover patients with preexisting conditions,” she wrote, “the authors worried that insurers would compensate by increasing the number of denials.”
Rosenthal said the Department of Health and Human Services was supposed to monitor insurance claim denials on Obamacare marketplace plans. Instead, automated denials are more common.
She said health insurance company Cigna employs an automated-claims denial system that signs off on 50 charts in 10 seconds — not enough time to even read the patients’ medical records.
“Automation makes the reviewing cheap and easy,” Rosenthal said. “The government has the power and duty to end the fire hose of reckless denials that are harming patients financially and medically,” she wrote. “Thirteen years after passage of the ACA, perhaps it is time for the mandated investigation and enforcement to begin.”
