Pat Youngblood , 2025-05-06 13:42:00
Nearly three in four providers say payers deny treatments they prescribe some of the time. More importantly many indicate this happens too frequently, takes up too much time and a significant number have considered quitting over the demands these engagements add to their jobs.
That’s according to a recent survey my company fielded through an independent panel. We polled 211 U.S.-based providers in January and February of this year.
Nearly half of those polled said they spend too much time going back and forth with insurance companies to approve the care they’ve prescribed to patients. The time it takes to remediate claims is time those same providers could be spending with other patients.
Claims denials are a growing concern
Other related surveys and studies have yielded comparable findings.
For example, a 2024 Experian survey of 200 healthcare staff responsible for billing and claims found 73 percent said claim denials are increasing. Further, 67 percent said payers are taking longer to reimburse claims that do go through. Some 77 percent were at least moderately concerned a claim would not be paid – including 43 percent who were very concerned or extremely concerned.
Similarly, KFF analyzed data from the Affordable Care Act (ACA) Marketplace and discovered similar results. Payers “denied 19 percent of in-network claims in 2023 and 37 percent of out-of-network claims for a combined average of 20 percent of all claims.”
Why? “The most common reason cited by insurers was ‘other’ at 34 percent followed by administrative reasons (18 percent), excluded service (16 percent), lack of prior authorization or referral (9 percent), and only 6 percent based on lack of medical necessity,” according to KFF.
‘My employer could do more’
Considering the compounding adverse effect re-work has on revenue, that alone merits the attention of healthcare employers. However, there’s another sound reason: recruiting and retention.
In the survey, 44 percent of healthcare providers who responded have considered leaving their position over this issue. What’s more, about one in three have considered quitting with some frequency.
These are concerning statistics, given the prolonged shortage of providers. Couple this challenge with the pervasive burnout across the medical community, and we can see the potential this collectively has to snowball.
Could employers do more to help providers with insurance challenges? Nearly half of those polled believe they could. This includes 36 percent who said, “My employer is mostly supportive but could do more” – and another nine percent said, “My employer is a little supportive but could do a lot more.” Finally, four percent said, “My employer is not supportive at all.”
What can healthcare employers do?
There are all sorts of systemic problems in our healthcare system – many are outside any individual employer’s immediate control. What an employer should do is focus on what they can control. To that end, one of the best places to start is by simply listening to what providers have to say about it. Below are a few actionable suggestions.
1. Get a baseline assessment in your organization
We recommend conducting a similar survey of the providers you employ to get a baseline assessment. Seek to understand if it happens and how often. This will give you the means to understand the extent of the problem and the risks to your organization.
Importantly, you also want to understand how much time providers are investing in remediating these issues. Quantifying the time provides you with a sense for estimating the financial impact with metrics such as the Work Relative Value Unit (wRVU).
Understanding the financial impact has two downstream effects. First, the numbers convey the scope of the problem in business terms everyone can understand. Second, those costs are effective benchmarks that could be the basis of a future business case for a proposed solution.
2. See what’s being done differently
Not every provider agrees this is a problem. For example, about 15 percent of providers we surveyed said payers “rarely” or “never” deny claims. In terms of the time it takes to address insurance demands, nearly 1 in 10 signaled the level of effort is about right.
These providers may have the solution. Polling is a way to identify them and then find out what they are doing differently.
Use that information to develop the best practices that can be shared across your team. For example, of those providers who feel the time required of them on insurance issues is reasonable – do they enter better notes – or do insurers simply have overzealous expectations?
3. Make it part of onboarding and exit interviews
The potential impact on human resources means it’s essential to address payer challenges during the onboarding and exit interview process. When you have a provider leave, this is an opportunity to get candid feedback as to how your organization can better address the increased demands insurance is placing on your providers.
Likewise, when your organization onboards a newly hired provider, use what you’ve learned to set new employees up for success.
‘Best for the patient’
The final question of the survey asked providers an open-ended question: If you could change one thing about healthcare insurance what would it be?
More than 200 providers offered their written thoughts. The vast majority chafed at what they perceive to be insurance companies second-guessing their medical decisions.
“The provider makes the decisions of what is best for the patient, not the insurance company,” wrote one respondent in a representative answer.
Indeed, the best interest of the patient is why many providers pursue a career in medicine – and perhaps also, why they stay. Insurance demands tend to be more about administration than it is about medicine. That’s a good reason for healthcare employers to do more to help providers manage frustration with payers.
Photo: pixelliebe, Getty Images
Pat Youngblood, DBA, SPHR is an executive with Intelliworx. He has a long history in healthcare – recruiting providers – and earned a doctorate in business where he studied the challenges of recruiting providers in rural America.
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