When two Boeing 737 Max airplanes crashed within the span of six months of each other, killing 346 people, black box recorders helped investigators find the cause. A similar kind of black box should be available to alert regulators, lawmakers, or the public to deaths due to health insurance company behavior.
Available evidence reveals that some commercial health insurance companies routinely fail to meet the health care needs of enrollees, although it’s impossible to know the full extent of the problem without more data. These companies hide their black box recorders — their internal records — even when they’re required by law to disclose them.
Insurance-related casualties will never create headlines the way airplane deaths do. They happen one at a time, outside the public eye. We’re left to guess which health insurers rely on coverage guidelines and protocols that cause harm. American families are expected to blindly spend nearly $30,000 in out-of-pocket costs and lost wages each year for health care coverage that may be putting them at risk.
Even so, evidence is emerging that some for-profit insurers have placed profits above the health and well-being of their customers. For example, a judge ruled in March that United Behavioral Health, a subsidiary of UnitedHealth Group, used inappropriate coverage guidelines to systematically withhold potentially lifesaving mental health care from 50,000 enrollees. The judge found that United Behavioral Health’s failure to adopt widely accepted coverage criteria “was not based on any clinical justification,” adding that the only reason “was that its finance department wouldn’t sign off on the change.”
All of United Behavioral Health’s clinicians disagreed with the company’s decision to ignore addiction treatment guidelines published by the American Society for Addiction Medicine. The attorneys who brought the case say they are aware of a number of deaths resulting from the denials of care, including two of the named plaintiffs, though the true number may never be known.
Commercial health plans that offer Medicare benefits, known as Medicare Advantage plans, provide further evidence that some health insurers secretly and systematically overcharge their members and deny them the care they need. The Office of Inspector General of the Department of Health and Human Services has reported “widespread and persistent [Medicare Advantage] performance problems related to denials of care and payment.”
The Centers for Medicare and Medicaid Services, which is charged with overseeing Medicare Advantage plans, has cited more than half of the plans it audited for inappropriately denying care. Medicare Advantage plans were also cited for “charging incorrect copayments to enrollees for medical services.” CMS audits have led to sanctions for dozens of Medicare Advantage plans.
In one particularly egregious instance, CMS barred Cigna from enrolling new Medicare Advantage members because its conduct posed “a serious threat to the health and safety” of its enrollees. “Cigna has received numerous notices of non-compliance, warning letters, and corrective action plans … over the past several years. … Cigna has not corrected issues of noncompliance,” the director of the Medicare Oversight and Enforcement Group wrote to Cigna.
It is unusual for CMS to warn people with Medicare about health plans that pose serious threats to the health and safety of their members. Instead, it may continue to give high ratings to such plans. That means the public is misled about the risks of joining these plans, with the black box recorder again remaining closed on these grave deficiencies.
The litany of wrongful and harmful behaviors by Medicare Advantage plans is surely greater than we know. The Government Accountability Office has criticized CMS for conducting insufficient oversight and audits of Medicare Advantage plans.
Meanwhile, for several years, Medicare Advantage plans have failed to release accurate and complete data about the services their enrollees receive, as required by law. This information would help CMS hold these plans accountable for the care they provide.
MedPAC, a nonpartisan agency charged with advising Congress on Medicare policy, has advised CMS to reduce payments to these plans until they turn over this information, as required by law. But CMS hasn’t done that yet, nor has it acted in any meaningful way to ensure these plans comply with the law.
Health insurance companies, like airplane manufacturers, hold our lives in their hands. But, for the most part, health insurers — unlike airplane manufacturers — are allowed to operate in the dark. The little we do know is troubling. We must demand that health insurance companies come out of the shadows. One needless death is one too many, whether it occurs in a plane crash or as the result of insurance industry misdeeds.
Diane Archer is the president of Just Care and the founder and past president of the Medicare Rights Center. Richard Eskow is a health policy adviser, a journalist, and a former chief writer for Bernie Sanders in 2016. Both are senior advisers at Social Security Works.