| By Maya Goldman |
 Data: KFF analysis of CMS data; Note: Data includes parent companies that received more than 5 million claims; Chart: Axios VisualsAffordable Care Act marketplace insurance plans denied an average of 1 in 5 claims in 2023, with two carriers denying as many as 1 in 3, according to a KFF analysis.Why it matters: Claim denials are one of consumers’ chief complaints with their health insurance and can make it harder for people to pay their medical bills.By the numbers: Federal marketplace insurance plans reported receiving 425 million claims in 2023, according to KFF’s analysis of federal data.92% were for in-network services, and insurers denied an average of 19% of those.Plans denied 37% of the remaining claims that were out of network, for an overall average of 20% of claims denied.Nine health insurance parent companies that received more than 5 million claims denied in-network claims at a rate of more than 20%, according to KFF’s analysis. Blue Cross Blue Shield of Alabama had the highest rate of denials at 35%.Read morefrom STAT:painFDA approves Journavx, Vertex’s non-opioid painkillerVertex Pharmaceuticals yesterday won approval for Journavx, a closely watched non-opioid pain drug for moderate to severe acute pain. The drug, which targets the NaV1.8 sodium channel, showed pain relief that was superior to placebo in trials — but it didn’t outperform opioids in controlling pain, STAT’s Jonathan Wosen writes.Still, there’s a pressing need for non-addictive pain treatments — and analysts predict up to $2 billion in peak sales.“I think it’s the socially responsible thing to prescribe something like this instead of opioids,” Wolfe Research analyst Andy Chen told STAT. “I just don’t think payers are going to enjoy the headline saying that, ‘Oh, Mr. Payer is declining approval for [the] medication, and payers prefer that patients use opioids.’ That would just be very bad PR.”Speaking of PR, curiously, the FDA issued this press release about the drug’s approval despite the Health and Human Services Department’s communications freeze. Read more.INSURANCEBig-ticket medical claims cost CignaInsurance companies increasingly are paying for a lot more unexpected, big-ticket health care procedures. Cigna is the latest to find out.Yesterday, the company disclosed that its fourth-quarter profits were well below what Wall Street expected. Executives attributed all of the higher health care expenses to its business that insures employers from catastrophically high medical claims, STAT’s Bob Herman reports.Cigna specifically called out oncology procedures, inpatient heart surgeries, and the use of cancer drug Keytruda and multiple sclerosis drug Ocrevus as the main sources of higher so-called “stop-loss claims.”from Politico: FIRST IN PULSE: DOC PAY FIX COMES TOGETHER — A bipartisan group of House members is offering a plan to fix the Medicare pay cut to doctors that went into effect this year after Congress declined to stop it, Daniel reports.The plan would effectively boost pay to eliminate the cut by 6.62 percent for the rest of the year— and provide extra payment to address inflation and offset the deficit from the cut in the first part of the year.Rep. Greg Murphy (R-N.C.), a urologist, plans to introduce the bill with a group of bipartisan lawmakers, several of them also doctors.Though the plan is set to be introduced as legislation today, its provisions will likely be pushed by the lawmakers for a must-pass government funding package in March.Why it matters: Mitigating Medicare pay cuts is a top priority for health providers, especially those struggling financially. Medicare pay to doctors decreased by 2.8 percent beginning in January, and the government estimates that the cost of practicing medicine will rise by 3.6 percent this year.The proposal’s bipartisan backing also comes as Democratic clinicians in Congress consider how they might organize to advance shared goals.Planning to introduce the bill with Murphy are Jimmy Panetta (D-Calif.), John Joyce (R-Pa.), Raul Ruiz (D-Calif.), Mariannette Miller-Meeks (R-Iowa), Kim Schrier (D-Wash.), Claudia Tenney (R-N.Y.), Ami Bera (D-Calif.), Carol Miller (R-W.Va.) and Raja Krishnamoorthi (D-Ill.). |
Leave a Reply