By Isaiah Grady and Mikayla Davis
Insurance is the staple of security and safety in our modern day society. When Americans make their monthly payment to their agency, they take comfort in the idea that they are protected. If any misfortune occurs, they will be covered by an insurance plan that will handle the expenses of life’s bumps and sudden curves. Or so they are told.
According to a study by the National Health Expenditure, the average American spends over $14,000 on health insurance per year. This comes after a 7.5% growth in healthcare spending seen in 2023. This number can vary from company to company. Some young adults are still living under a family plan that will last until they are the age of 26. After that, each patient is effectively on their own.
An average doctor check up is about $150 per visit. Even if you opted out of an annual trip to the clinic, a sudden trip to an emergency room runs $1,500-$3,000 out of your savings. This does not factor in any other expenses such as ambulance transportation fees or drug treatments. These prices in the American world of medicine have incentivized patients to invest in insurance.
Chart showing insurance coverage rates in 2023 provided by KFF
As a consumer, one would expect an insurance company to ease the burden of some of these medical bills. To be frank , most do while others are finding ways to make even more profit through the various loopholes in the industry.
The healthcare industry has made a standardized list of codes and statutes to clarify an adjustment or denial to an insurance claim. These are known as the Claim Adjustment Reason Codes (CARC). While other types of insurances use different kinds of code systems, they all are designed to make denial claims as transparent as possible. However sometimes it’s hard to tell if these companies have any sort of ethical considerations when making these decisions.
Texas surgeon Elizabeth Potter posted a video online alleging her patients insurance had denied her coverage. In the TikTok clip, Potter alleges she was interrupted during a critical surgery with her patient. She called while removing tumors to ask her if an overnight stay would be “justified”. The company in question was United Healthcare, widely known for its high denial rates.
The company made headlines this past December after its CEO Brain Thompson was killed in New York. His alleged assassin, Luigi Mangione. was arrested 3 days later.
While the trial is ongoing, officials in Pennsylvania claim to have suspected that his motivations were driven by the company’s denial of coverage for a spinal injury occurring in 2023.
The bullet casings at the scene read ‘deny, defend, depose” referring to tactics taken by insurers. The horror stories don’t end there.
ABC news reported that 22 year old Coleman Schmidtknecht died from an asthma attack. This came after the Wisconsin native was denied coverage of a much needed inhaler. OptumRx, a subsidiary of UnitedHealth, stopped covering the inhalers he had been using for a decade.
Stories like this are not limited to just one section of the industry. Take home insurance as an example.
The recent LA wildfires have decimated many suburban neighborhoods leaving thousands homeless. A CNN report found that 2.8 million residents have been denied an insurance renewal.
A policy change to California’s Fair Plan act last year requires homeowners to face the cost of rebuilding from huge disasters by sticking them with larger insurance bills, regardless of whether they were affected by the Los Angeles wildfires.
This means homeowners across the state could be forced to suffer the costs of the L.A. fires.
Insurers heavily pushed the rule change but it was ultimately put into place by the California insurance regulator.
The new rules allow insurance companies to charge customers if they must bail out the plan, which has an estimated $200 million in cash and $2.5 billion in reinsurance, according to last year’s data.
ABC News reports that the costs from the fires could reach up to $40 billion for insurers, the highest amount for any fire in recent history. Meaning, the fire victims are no better off than if they hadn’t bought insurance in the first place.
As more and more people start to invest in insurance, many are posed with the question, is the price tag worth it?
Protesting Trump’s early actions, many people gathered at the Capitol building Monday and Wednesday of last week. The phrase deny, defend, depose reflects the frustrations many citizens have with insurance companies but has since grown to symbolize systematic failures and injustice.