Feds help health insurers hide their dirty secret: denials on the rise

Murder, ethics, and cognitive dissonance

• Heated debate over the line “no industry malfeasance could ever excuse murder.”
• Some argue killing can be ethically justified (e.g., self‑defense, wartime, death penalty), so the statement “nothing excuses murder” is inconsistent with US practice.
• Others distinguish murder (unlawful killing) from lawful homicide (death penalty, self‑defense), saying that’s why people can oppose the CEO killing while supporting capital punishment.
• Several point to US wars, police killings, and extrajudicial assassinations as evidence that society already accepts large‑scale killing while condemning this one.

Is denial of care a kind of killing?

• Many argue that knowingly denying life‑saving treatment (or coverage) is morally akin to homicide, possibly even premeditated.
• Counter‑view: disease/injury kills; insurers only withhold financial support, so calling it “murder” is sophistry.
• Others emphasize omissions and “duty of care”: neglect can be negligent homicide in law and a serious moral wrong in ethics and religion.

Claim denials and their rise

• Cited figures: denials around ~1–2% in 2013 vs ~15% on average by 2022, with some payers approaching ~50% (sources in thread).
• 41% of appealed denials reportedly get reversed, suggesting many are incorrect or abusive, but appeals are rare and burdensome.
• Some denials are due to coding errors; others come from automated systems and aggressive prior auth.

Patient experiences

• Multiple anecdotes of denials for colonoscopies or anesthesia, preventive tests, imaging, and cardiac monitoring.
• People describe large surprise bills, debt collection, and hospitals having entire “denial teams.”
• A few note that colonoscopies without sedation are common elsewhere and medically acceptable; others report severe pain and insist sedation is necessary care, not luxury.

Root causes and blame

• One camp blames profit‑driven insurers: incentives to deny, complex rules that manufacture “errors,” vertical integration, and AI‑driven claim rejection.
• Another camp stresses provider overbilling, unnecessary treatments, and constrained physician supply as major cost drivers; insurers often only administer self‑funded employer plans under medical loss ratio caps.
• Several argue that all systems ration care; in other countries, rationing is more centralized and less visible to patients.

Reform ideas

• Proposals include: single‑payer or strong public option; nonprofit insurers with national fee schedules; catastrophic‑only insurance plus transparent cash prices; strict audits and penalties for wrongful denials; or criminalizing harmful denials and piercing corporate liability.
• Broad frustration that meaningful reform is blocked by bipartisan lobbying, partisan gridlock, and public resistance to concrete trade‑offs on taxes, coverage, and limits.