Health insurance costs far outpace inflation, forcing more consumers to pay thousands of dollars in out-of-pocket costs each year. At the same time, some insurers reject nearly one in five claims. This double whammy forces Americans to pay more for coverage while sometimes feeling like they’re getting less in return, experts say.
Frustration over denials and medical costs fueled a wave of protests. vitriol against health insurance companies following the murder from UnitedHealthcare CEO Brian Thompson. Also last week, a similar outcry led Anthem Blue Cross Blue Shield to cancel a decision to limit anesthesia coverage during surgical procedures.
Anger may be rooted in fears that unexpected medical expenses will prove financially ruinous, as well as fears that essential care may be denied by an insurer, endangering the very health and well-being of those who have health insurance.
Some of these concerns are valid: The leading cause of bankruptcy in the United States is health care debt, highlighting the financial stress that can arise from high medical costs.
In fact, most adults report worrying about their ability to pay for health services or unexpected medical bills, a sentiment shared by people whether they are financially comfortable or struggling, according to a survey by the KFF earlier this year.
In 2024, the average health insurance premium for families was $25,572 per year, while single workers paid an average of $8,951, an increase of 6% and 7% from the year previous, according to KFF data. Since 2000, health insurance premium increases have outpaced inflation for almost a few years, the health policy research firm found.
“The dissatisfaction with insurers comes from two things: ‘I’m sick and I’m being harassed,’ and the second is a very high cost: ‘I’m paying more than before and I’m paying more than my salary.’ has increased,” said Rob Andrews, CEO of the Health Transformation Alliance, a cooperative representing large companies such as American Express and Coca-Cola that is working to improve health insurance for their employees. “A lot of people think they’re getting less” from their insurers, Andrews said.
And although Americans have unfortunately faced other types of inflation in recent years, exorbitant grocery prices were credited with helping President-elect Donald Trump win last month — health insurance can take an even more personal edge, Thomas pointed out.
“It’s not like, ‘How much should I pay for a lawn chair or a steak,'” Andrews noted. “People are sick or have a health issue that they’re worried about.”
To be sure, people with employer-sponsored health insurance typically don’t pay the full premium, because their employers pick up much of the bill.
Yet KFF data shows that the share of employee contributions is also increasing, with a worker with family coverage typically paying premiums of $5,700 per year in 2017, the most recent year for this data, compared to about $1,600 in 2000, according to KFF data. watch. The average family deductible — the amount paid out-of-pocket before insurance kicks in — increased from $2,500 in 2013 to $3,700 in 2023, according to KFF.
Last year, about 81% of Americans said they were dissatisfied with the cost of health care in the United States, a 16-year high, according to a Gallup poll.
“We’ve gotten to a point where health care is so inaccessible and unaffordable that people are justified in their frustrations,” Dr. Céline Gounder, CBS News medical contributor and public health editor at CBS, told CBS News. KFF Health News. Friday morning.
Refusal of health insurance
In addition to rising health insurance costs, Americans are also expressing anger over coverage denials, which, according to a KFF analysis of qualified nongroup health plans in 2021, impacted nearly one in every claim. five. However, their study found that denial rates varied widely across insurers, with some as high as 2% while others were as high as 49%.
“When you pay for something, and then they don’t give it to you and keep raising the prices, of course you’ll be frustrated by that,” noted Holden Karau, a software engineer who created a free service called Fight Health Insurance. to help people appeal their refusals.
Karau says she created the app, which uses AI to write appeal letters, after her own and her dog’s experience with insurance. Her pet insurer initially refused to pay for anesthesia for her dog’s root canal, while Karau, who is transgender, said she fielded numerous calls to have her own procedures and surgeries covered by his insurance.
More and more insurance companies are using AI to review claims and issue denials, which is not always obvious to consumers. The shift to AI-based exams has sparked lawsuits against insurers, with UnitedHealthcare continued last year by the families of two now-deceased clients who alleged the insurer knowingly used a faulty algorithm to deny elderly patients coverage for extended care deemed necessary by their doctors.
“With AI tools on the insurance side, they have very few negative consequences for refusing procedures,” Karau added. “We’re seeing very high refusal rates triggered by AI. And on the patient and provider side, they don’t have the tools to fight back.”
Most people may not know they have the right to appeal a denial, Karau noted. The majority of people faced with a refusal or billing error do not dispute, according to a study find earlier this year. For those who do, an initial appeal will be handled by the insurer, but if that internal appeal is also denied, you have the right to have an independent examiner review your claim, according to the National Association of Insurance. Commissioners.
“There are several levels of appeal and, in my experience, I would say it’s important to appeal until you at least get to an independent evaluator,” Karau said. “If you don’t appeal, you won’t get the care you need.”
