Over the weekend, CBS News aired an important and timely segment examining the challenges millions of Americans face in accessing health care services due to insurance companies denying coverage for necessary tests and treatments.
The piece opens by sharing the story of the Hurleys, a husband and wife who are both physicians, with a focus on Dan Hurley, an ENT specialist, and his fight for coverage of his treatment at the same time he was fighting cancer.
Dan died in August 2023 after his cancer battle. In the CBS News piece, Traci offers her perspective on the simultaneous battle they were forced into with their insurance company: “No family should have to go through having to fight to get treatment covered, while fighting for their lives,” she said. When insurers deny medically necessary care prescribed by a doctor, “the act of signing that denial is practicing medicine.”
Last year, CHA continued its litigation against Anthem, one of California’s largest health insurance companies, to fight back against practices that consistently leave thousands of its patients stranded in hospital beds long after they have been medically cleared for discharge — a violation of California law.
The initial ruling from Los Angeles Superior Court sided with CHA on the merits of the case — concluding that it is health plans’ responsibility to arrange for and transition to post-acute care services for their members — but decided it would “abstain” from further involvement — that is, from providing a remedy. CHA’s appeal of that abstention is pending.
The data upon which CHA’s lawsuit is founded show that victims of discharge delays are forced to stay in hospitals longer, are deprived of timely post-hospital health care services, and cause backlogs for other patients who have to wait longer for hospital beds.
The CBS News piece highlights many of the concerns inherent in CHA’s lawsuit, including that insurance denials are common and impactful and that appeals are rare and difficult, meaning many patients give up before getting care.
The piece goes on to note that doctors and former insurance industry insiders say the system often prioritizes profit over health outcomes. Unlike other industries, increased use means less profit, so the goal becomes preventing care rather than providing it.
And patients and clinicians alike view current practices as barriers to care. As one doctor says, insurance companies have “made it more difficult to be healthy in the United States.”
