Commercial Insurance Practices

Private commercial insurance is critically important to those who receive coverage through their jobs, as well as for Medicare and Medicaid beneficiaries who rely on private insurers to administer their health benefits.

Unfortunately, the way some commercial insurance companies operate creates significant overhead for hospitals and dangerous care delays for patients. 

Overly burdensome policies, such as inappropriate use of prior authorization practices, slow and could deny access to needed and appropriate care.

These practices add significant cost to the system — requiring hospitals and health systems to jump through unnecessary administrative hoops. They affect timely patient discharge to the next care setting or to home, meaning patients remain in the hospital when they no longer need to be there.

Other commercial insurance practices including prepayment and postpayment audits, downcoding, and unnecessary clinical reviews reduce payments and add cost to the system.  Action is needed to address these ongoing issues and systemic cost drivers to improve healthcare access.