How healthy employers can do more to help suppliers manage payers’ frustration

Almost three out of four providers say that payers refuse treatments that they prescribe part of the time. More importantly, many indicate that this happens too frequently, takes too much time and a significant number has considered leaving the requirements that these commitments add to their work.

It is according to a recent survey that my company presented via an independent panel. We interviewed 211 American suppliers in January and February of this year.

Almost half of the respondents said that they had too much time going back and forth with insurance companies to approve the care they had prescribed to patients. The time required to remedy complaints is the time that these same providers could spend with other patients.

Refusal of complaints are an increasing concern

Other surveys and related studies have given comparable results.

For example, an Experian survey in 2024 in 200 health staff responsible for invoicing and complaints revealed that 73% declared to increase. In addition, 67% said that the payers took more time to reimburse the complaints that continue. Some 77% were at least moderately concerned that a complaint would not be paid – of which 43% which were very concerned or extremely concerned.

Similarly, KFF analyzed data from the Acting Acting Acts Market (ACA) and discovered similar results. The payers “refused 19% of network complaints in 2023 and 37% of complaints outside the network for a combined average of 20% of all complaints”.

For what? “The most common reason cited by insurers was” another “at 34%, followed by administrative reasons (18%), excluded service (16%), lack of prior authorization or reference (9%), and only 6%depending on the lack of medical necessity”, according to KFF.

‘My employer could do more’

Given the undesirable effect of the re -evaluation, the resumption of income has on income, which alone deserves the attention of health employers. However, there is another good reason: recruitment and retention.

In the survey, 44% of health care providers who answered planned to leave their position on this issue. In addition, approximately one in three planned to stop with a certain frequency.

These are statistics concerning, given the prolonged shortage of providers. Combine this challenge with omnipresent professional exhaustion throughout the medical community, and we can see the potential that this has collectively in the snowball.

Could employers do more to help suppliers with insurance challenges? Almost half of those questioned believe they could. This includes 36% who said: “My employer is mainly favorable but could do more” – and nine percent said: “My employer is a little favorable but could do much more.” Finally, four percent said: “My employer does not support each other at all.”

What can health care employers do?

There are all kinds of systemic problems in our health system – many are outside the immediate control of any employer. What an employer must do is focus on what he can control. To this end, one of the best places to start is simply to listen to what suppliers have to say about it. You will find below some usable suggestions.

1. Get a basic assessment in your organization

We recommend that you conduct a similar investigation with suppliers you use to obtain a basic 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 for your organization.

Above all, you also want to understand how long suppliers are investing in solving these problems. The quantification of time gives you a meaning to estimate the financial impact with measures such as the Relative work value unit (WRVU).

Understanding the financial impact has two downstream effects. First, the figures transmit the scope of the problem in commercial terms that everyone can understand. Second, these costs are effective benchmarks that could be the basis of a future profitability analysis for a proposed solution.

2. See what is done differently

Not all suppliers are suitable for a problem. For example, around 15% of the providers we interviewed interviewed the said “rarely” or “never” of complaints. Regarding the time required to respond to insurance requests, almost 1 in 10 reported that the level of effort is almost correct.

These suppliers can have the solution. The survey is a way to identify them, then discover what they do differently.

Use this information to develop best practices that can be shared through your team. For example, providers who believe that the time required on insurance problems is reasonable – do they have better ratings – or do insurers simply have too zealous expectations?

3. Be part of the integration and output interviews

The potential impact on human resources means that it is essential to meet the challenges of payers during the integration and exit interview process. When you have a supplier leave, this is an opportunity to obtain frank comments on how your organization can better respond to increased requests than place insurance on your providers.

Likewise, when your organization on the tips of a newly hired supplier, use what you have learned to prepare new employees to succeed.

‘Better for the patient’

The last question of the survey asked an open question: if you could change something about health care insurance, what would it be?

More than 200 suppliers have offered their written thoughts. The vast majority rubbed out what they perceive as insurance companies in the second title of their medical decisions.

“The supplier makes the decisions of what is best for the patient, not the insurance company,” wrote a respondent in a representative response.

Indeed, the best interest of the patient is the reason why many suppliers are pursuing a career in medicine – and perhaps also why they remain. Insurance requests tend to be more on administration than on medicine. This is a good reason for health employers to do more to help suppliers manage frustration with payers.

Photo: Pixelliebe, Getty Images

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