Improving Insurance Processes for Patients in Colorado

What You Need to Know:
Our patients rely upon a functional and collaborative relationship between providers (clinicians and hospitals) and third-party payers (insurance companies) to ensure that they can receive essential health care services in a timely manner. Health insurance companies are making it harder all the time for hospitals to get paid for care that is necessary, and in many cases, that was already authorized and provided to patients. This adds significant delays and unnecessary costs to the health care system.

Colorado Hospital Perspective:
In a survey of CHA member hospitals and health systems, more than 90 percent of respondents said insurance company issues are significant and getting worse. 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.

“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

Taking Action:
CHA has joined a coalition of other health care providers on legislation to fix some of the many prior authorization challenges used by insurance companies. As part of Health Can’t Wait Colorado, CHA supports House Bill 24-1149 to require that insurance companies eliminate or modify onerous prior authorization requirements.

Getting timely treatment doesn’t have to be this hard. We can simplify the process for both patients and providers through commonsense reforms to the prior authorization processes used by insurance companies.

CHA Contact: Joshua Ewing, CHA vice president of government affairs | [email protected]