Medical providers and patients in Arizona are hitting a wall with rising health insurance claim denials, a trend that's putting critical medications and services further out of reach. Brittany Panico, a rheumatologist in Gilbert, recounted the struggles at a town hall meeting in September, detailing an almost year-long battle to secure approval for a gout medication, according to a report by ABC15. Panico's patient story isn't unique, reflecting a broader pattern of denial rates outstripping the national average.
The impact of these denials can be financially devastating for both the providers and patients. Arizona's in-network insurance denial rate stood at an alarming 21% in 2023, as reported by Kaiser and mentioned by ABC15. This figure overshadows the national average denial rate of 19%. Insurers often deflect by pointing to issues such as improper coding or incomplete claim submissions, as discussed at the town hall.
Add to this, companies like Cigna are restructuring their reimbursement policies, potentially lowering payments for providers. Cigna's Evaluation and Management Coding Accuracy, which kicks in this week, would quantify service worth based on claim complexity, which, as Panico points out, "instead of us getting reimbursed for the services we provide, they are automatically lowering our (service) worth," as mentioned on ABC15.
Nancy Higgins of Pioneer Sports and Spine shared her story at the town hall, detailing how Cigna denied all of their claims, leaving them $50,000 short. "Cigna basically denied all of our claims," Higgins said, according to the town hall notes obtained by ABC15. "We had about 80 claims we submitted, and then we called Cigna because we didn’t get paid, and they said we didn’t have any claims on file." This signals systemic issues within the insurance claims process that are causing significant strife among medical practitioners.
These ongoing insurance battles are altering the healthcare landscape, with more providers preferring cash-pay clinics to avoid such clerical and financial headaches. "The constant struggles with insurance companies have caused the number of cash-pay clinics to 'skyrocket,'" Panico told BizJournals. Patients, however, must then shoulder the full cost of care without the leverage of insurance coverage.
With the Arizona Attorney General's office engaging directly by hosting town halls and initiating investigations into these denial practices, there's a concerted effort to confront the systemic issues head-on. "I do not intend to delay on this," Attorney General Kris Mayes said in a commitment to tackle the problem, as ABC15 reported.
