TAMPA, Fla. — During our coverage of our Patient No More investigative series, you have seen the anger, felt the frustrations, and witnessed the tears of several patients who told us their medical claims were denied and, in many cases, for life-saving measures.
“There were times I felt like I'd be better off dead instead of trying to fight, trying to keep going, trying to survive,” said Linda Brown.
Doctors have also spoken to us about their frustrations, many taking their frustrations to social media and quickly garnering national attention.
"I don't want to treat them like the bad guy, I want them at the table. I want them to work with us," said Dr. Alicia Billington, a Tampa board-certified plastic and reconstructive surgeon.
A SEAT AT THE TABLE
As part of our reporting, we wanted to give the major health insurance carriers a seat at the table, hoping for a response on how the industry has changed since Dec. 4 when United Health Care's CEO and president was gunned down.
We emailed and called the top 10 major health insurance companies in the United States and dozens of their lobbyists in Florida, representing them on their behalf to lawmakers.
None of the lobbyists would talk. One group even declined an interview due to "political ramifications."
Cigna Health, Elevance Health, which includes Anthem Blue Cross and Blue Shield, and CVS Health, which represents Aetna insurance, all declined to comment, instead referring us to their lobbying group, the Association of Health Insurance Plans.
They also declined an interview.
Instead, AHIP sent us this statement:
“In the fragmented and heavily regulated health care system, health plans, providers and drugmakers share a responsibility to make high-quality care as affordable as possible and easier to navigate for the people we collectively serve. Health plans are working to protect patients from the full impact of rising costs while connecting them to care that is safe, evidence-based and coordinated.”
Cigna Health did point us to a video posted online of its chief health officer acknowledging that there needs to be a shift in how health plans respond. He added that transparency and trust are now part of a new plan to improve patient experience at the Cigna Group.
"Healthcare works for a lot of people in America, but for too many, it doesn't work," said Cigna's Chief Health Officer Dr. David Brailer. "We can do better. We are going to do better."
Still, Cigna Health did not agree to an interview.
'ROCKED THE WHOLE ENTIRE INDUSTRY'
The only person who agreed to do an interview with us was Al Marino, a licensed insurance agent who sells healthcare insurance in Florida. He spoke to us as part of Professional Insurance Agents of Florida.
"Why do you think these health insurance companies don't want to speak publicly about what's happening or even acknowledge kind of the rhetoric of our nation right now?" asked ABC Action News Anchor Nadeen Yanes.
"I really can't speak for the insurance companies. I am an insurance agent, and I work with both insurance companies and with their customers, But you know, this whole thing definitely rocked the whole entire industry," Marino said. "That somebody could just be executed on the street like that. And, you know, that rocked everybody. The health plans, they're not running and hiding. They're definitely out there to talk to the members."
But they aren't speaking to us.
"How does the health insurance industry, as a whole, move forward from this?" Nadeen asked.
"I think it's constant evolution, and I think companies are definitely looking at addressing how they can make the claims process faster, whether it's through AI or through some different outreaches, to make sure that they are getting to the point where they're taking care of the customer before the customer is actually at that frustrated level," Marino added.
FLORIDA HEALTH PLANS RESPONSE
ABC Action News also reached out to the Florida Association of Health Plans, the state lobbyist group for health insurers carriers. They also declined an interview but sent us this statement.
The Florida Association of Health Plans (FAHP) represents commercial, Medicaid and Medicare Advantage health insurers, and managed care organizations. Florida’s health plans provide robust benefits and services to improve the health and well-being of all Floridians.
To ensure members are getting the best care that will result in the best outcomes, health plans employ highly experienced physicians to review cases and determine medical necessity. These determinations are made based on established clinical guidelines and individual patient needs.
Reviewers adhere to processes that are governed by rigorous checks and balances to safeguard patient access to appropriate care. Treating physicians have the right to request peer-to-peer reviews when they disagree with initial denial alerts. Furthermore, treating physicians and patients can appeal authorization and claims decisions. These appeals are then reviewed by physicians with relevant credentials and appropriate specialty expertise.
FAHP member health plans also provide Member Advocates who offer support and guidance to patients, ensuring they have the necessary assistance to navigate the system.
FAHP and its members remain dedicated to providing accessible, affordable, high-quality health care to the 21 million Floridians that health plans serve.
Editors note: On background, many across the industry say they are shocked by how media outlets are publishing inflammatory stories they say don't show the complex, costly and complicated health care system. They told us they feel the responsibility is shared among doctors who perform unnecessary medical procedures and hospitals who do not provide accurate billing information or purposely overcharge. These sentiments could not be attributed to a single health insurance carrier or organization. If any representative or lobbyist in the healthcare industry would like to be part of this Patient No More series, the offer still stands.
"I felt like it was really strong-arm robbery."
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