FRIDAY, June 16, 2023 (HealthDay News) — A majority of insured Americans have struggled with a wide array of stumbling blocks when trying to get coverage for their health care needs, a new national survey shows.
All told, the KFF report uncovered numerous obstacles to coverage with all types of health insurance, including an inability to find a covered in-network provider; delays in getting needed care; unexpected out-of-pocket costs; problems meeting preauthorization requirements; and outright denial of claims.
“We found that most people — about 60 percent — experience problems when they try to use their coverage,” noted survey lead Karen Pollitz, a senior fellow for health reform and private insurance at KFF and co-director of KFF’s program on patient and consumer protections. “We also found consumers can only fix their health insurance problems about half of the time, while about 30 percent of those with problems don’t try at all or give up.”
Other main findings included that most consumers (51 percent) have difficulty understanding their coverage and how it works; that most (60 percent) are unaware that they have legal rights to appeal a denied claim; and that most (76 percent) do not know what government agency to call when they have problems with their insurance.
Pollitz and her team conducted an online and phone survey of more than 3,600 people between February and March that focused on four groups of patients: those who get their primary insurance through their job (978 patients); those covered by Medicare (885); those covered by insurance they buy directly through the Affordable Care Act marketplace (880); and those covered by Medicaid (815).
On the upside, most of those surveyed (81 percent) said their health coverage was either “good” or “excellent” overall. That figure dipped in lockstep with declining health, however, falling to just 67 percent among those who indicated their health was “fair” or “poor.” And even while expressing a generally positive view of their insurance, most of those surveyed said they had had some problems with their coverage.
While about six in 10 of all respondents said they had run into an insurance problem in the prior year, that figure rose to about 67 percent among adults in poor or fair health. By comparison, only about 56 percent of those in good health reported a recent negative experience with their coverage.
Among those who experienced insurance problems, about one in six said they could not get the care they needed as a result. About 15 percent said their health actually got worse as a consequence of such problems, and nearly three in 10 said when they did get care their out-of-pocket costs were higher than anticipated.
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