It’s one of the most crucial questions people have when deciding which health plan to choose: If my doctor orders a test or treatment, will my insurer refuse to pay for it? After all, an insurance company that routinely rejects recommended care could damage both your health and your finances. The question becomes ever more pressing as many working Americans see their premiums rise as their benefits shrink. Yet, how often insurance companies say no is a closely held secret. There’s nowhere that a consumer or an employer can go to look up all insurers’ denial rates — let alone whether a particular company is likely to decline to pay for procedures or drugs that its plans appear to cover.
Jenn Coffey was so tired of having her care denied by her Medicare Advantage insurer that she signed a do-not-resuscitate order. “There was no more hope,” she said. “There was nothing left for me to hope for.” Coffey, a former EMT from Manchester, New Hampshire, went on Medicare, the government health insurance program for seniors and others with disabilities, after a breast cancer diagnosis left her unable to work. Like an increasing number of Medicare beneficiaries, she ended up on a for-profit Medicare Advantage plan; a marketer directed her to an option administered by UnitedHealth Group, a $450 billion insurer.
On Saturday, April 1, New York state lawmakers and Gov. Kathy Hochul failed to agree on a state budget. The governor proposed an extension until April 10, which was quickly passed by lawmakers to avoid a government shutdown — and then passed another extension, which expires Monday. These delays are reportedly because of disagreements over Hochul’s bail reform and controversial plans to create new housing. But another group is also watching the budget closely: home care workers, users and advocates, who pushed for and won a minimum wage increase for home care workers in the state budget in 2022, only to see those measures rolled back this year.