Health Insurance Issues

What You Need to Know:

The role of an insurance company is to pay claims for covered services provided to their members—full stop. Yet insurers have inserted themselves into clinical decision-making, and the regulatory environment allows them to override or delay care contrary to a patient’s provider. They are additionally allowed to deny coverage if a patient fails to pay premiums.

At the same time, insurance premiums, deductibles, and out-of-pocket costs continue to rise while coverage becomes more restrictive, leaving many patients underinsured. However, hospitals are legally required to provide care regardless of a patient’s ability to pay. While insurers set co-pays and deductibles, hospitals and providers are left responsible for collecting those payments.

Colorado Hospital Perspective:
A 2026 survey of CHA member hospitals and health systems revealed troubling results.

Due to recent changes by insurance companies, hospitals invest significant resources to manage health insurer requirements, diverting staff and time away from patient care. For examples:

  • Colorado hospitals report findings similar to a national study by the American Hospital Association (AHA), which found that 95 percent of hospital report increases in staff time seeking prior authorization approval.
  • Additional requirements add unnecessary cost to the system. In the same AHA survey, 84 percent of hospitals said the cost of complying with insurer policies is increasing.
  • Carriers are not paying when services are provided to patients. Fifteen percent of all first claims are denied, and 57 percent of initial claims denials that are appeals are ultimately overturned.

Taking Action:
In 2024, CHA joined a coalition of other health care providers to create and pass legislation to fix some of the many prior authorization challenges used by insurance companies. The Health Can’t Wait Colorado coalition supported House Bill 24-1149, which will require that insurance companies eliminate or modify onerous prior authorization requirements.

“We have a very large staff (for CAH) of prior auth staff on front end. Despite very well trained staff, the carriers deny treatment after a proper denial was obtained. They apply retroactively as well. This is crippling and actually adds cost to the health care system, by requiring facilities to hire so many staff to combat the continued nonpayment for services rendered.”
- Colorado Hospital Leader

Additional Resources

Doctor explaining something on their tablet to a patient

AHA Report: Commercial Insurer Policies are Impacting Patient Care

AHA Survey: Commercial Health Insurance Practices that Delay Care, Increase Costs

Medicare Advantage Fact Sheet Consumer

CHA Guide: The Facts About Medicare Advantage

AHA Report: Commercial Health Plans' Policies Compromise Patient Safety and Raise Costs

Medicare Advantage Fact Sheet Hospital

CHA Guide: Holding Medicare Advantage Plans Accountable

Carrier Issues Fact Sheet

CHA Fact Sheet: Improve Insurance Processes for Patients

Shining a Light on Health Insurance Practices

Medicare Advantage routinely denies reimbursements for necessary care, hospital execs say
You Have a Right to Know Why a Health Insurer Denied Your Claim. Some Insurers Still Won’t Tell You.
Who profits most from America’s baffling health-care system?
Most Americans with mental health needs don't get treatment, report finds