Catholic Health Association challenges denials of care by insurance companies

NEW YORK – With the creation of a new “Alliance for Access to Care” initiative, the Catholic Health Association and American Hospital Association aim to raise awareness on barriers to care faced by patients because of certain tactics used by commercial health insurance companies.

“We’re uncovering more and more barriers to care that need to be made public, so that we could impress upon our policymakers that changes need to happen,” Sister Mary Haddad, President and CEO of the CHA told Crux.

“This is a broken system, and so until we’re able to address the multiple issues that have contributed to this unjust health system in the United States we’re never going to be able to fix it,” she said.

Haddad said the biggest barrier to care patients face are insurance denials. Essentially, this happens when a physician makes a recommendation for a particular treatment, but the insurance company won’t pay for it.

“Oftentimes it’s looked at that a patient can’t get it because the hospital doesn’t provide the care, when really … it’s the insurance company that doesn’t pay for it, and that often directs what a patient will be able to do because they can’t afford it, and don’t want to assume that risk,” Haddad said.

Through the “Alliance for Care” initiative, this is the type of action the two organizations want to educate the public about, as the first step towards eventual congressional action. The initiative was launched through a new website, www.healthcarehere.org, where the header of the homepage reads, “Your Pain, Their Gain: How health insurers profit off denying care.”

The website, split into six sections, contains statistics about the practices employed by insurance carriers. The website states that, of 1,000 surveyed doctors who are a part of the American Medical Association, 94 percent said prior authorization – insurance companies’ requirement for pre-approval before treatment – delayed patients access to necessary care, 80 percent said that the prior authorization then led patients to abandon doctor recommended care, and 25 percent said the prior authorization denial eventually led to a patient’s hospitalization.

The website also notes that commercial insurers have raised premiums 14.5 percent over the past five years. It ahighlights the practice of using an algorithm to approve or deny a claim, citing for example that Cigna spent an average of 1.2 seconds per case to deny more than 300,000 claims.

And in another section, the website highlights 2022 profit increases for several major commercial insurance carriers: UnitedHealth Group’s profits increased 28 percent, Cigna’s 70 percent, Elevance Health’s 7 percent, Centene’s 26 percent, and Molina’s 60 percent, according to the website.

None of the providers listed above immediately returned a Crux request for comment.

Haddad said the creation of the initiative, which in addition to the website will include a paid advertising and social media campaign, was the culmination of a series of things, particularly hearing more and more from association members about the problems patients faced with barriers to care.

“We’ve been looking for quite some time at the incredible work that was led by my predecessor Sister Carol Keehan, my predecessor, on access to care with the Affordable Care Act, and we recognize that wasn’t the end goal just getting the passage of the ACA but that there would still be a lot of barriers to address and uncover that really have an impact on people in need,” Haddad said.

“That really was the impetus of this, saying we’re at a point in time now where we really need to elevate what’s happening to tell the truth about the challenges many people face in trying to access affordable health care,” Haddad said.

The Catholic Health Association represents more than 600 Catholic hospitals and 1,600 Catholic long-term care and other health facilities in the United States. Meanwhile, the American Hospital Association brings together about 5,000 hospitals, health care systems, networks and care providers.

Haddad said the organizations have worked together in the past, and because this issue affects more than just Catholic but not-for-profit care providers in general, that it made sense to launch the initiative together. She said it’s “timely to start telling the truth on this issue.”

“Step one is just to educate the public,” Haddad said. “That this is what’s wrong, and for too long it has gone under the radar, and that’s why it’s timely that we start telling the truth about this so we can impact that change that needs to happen because this is not sustainable the way we’re providing care today.”

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