CMC sees rise in denied insurance claims, a nationwide trend

If you’ve received an unexpected hospital bill recently due to your insurance company denying payment, you’re not alone: Coulee Medical Center staff reported an uptick in denials by insurers when the hospital attempts to collect on claims.

“They’re hanging up on our billers when they call,” Chief Financial Officer Kelly Hughes told the hospital board last month as part of her monthly financial report.

It’s an issue that goes far beyond the Coulee area, and in fact appears to reflect a nationwide trend that started to become evident to hospitals in 2023, according to Eric Lewis, the Washington State Hospital Association’s chief financial officer. 

“I think it’s a major nationwide problem that’s hitting Coulee, but it’s also across the state and quite frankly, across the country,” Lewis said. “Health payers are doing more initial denials, which causes hospitals to have to hire more employees and work those claims again. They eventually get paid for them, but the initial denial increases costs and decreases cash flow. We’re just beginning to investigate and look into this.”

Meanwhile, the impact has started to trickle down to members of the community beyond the hospital, said Coulee Medical Center Board Member Lee Seekins. She said she’s heard from people who received surprise bills, months after they were seen at Coulee Medical Center, for services that normally would be covered by an insurance provider.

“And panic sets in,” Seekins said. “I’ve had so many conversations in the last month or so. Just take a deep breath: You’ll beat that bill. Contact Billing. But it’s frustrating across the board.”

Lewis noted that there is a lawsuit out of Minnesota alleging UnitedHealth was using artificial intelligence to illegally deny patients care owed to them under Medicare Advantage Plans. 

“We don’t know what’s going on in Washington,” Lewis said. We’re just collecting data, but you know, insurance companies, if they do initial denials, it increases their cash flow. And it’s hard for hospitals to work every claim and get timely payment. Especially the smaller, rural hospitals. I think it’s a real challenge.”

The increased denials have been coming from commercial insurance, Medicare Advantage, and Medicaid managed care.

Hughes, with CMC, said it’s impacting the hospital’s bottom line, but she is hopeful that working together with other hospitals they will, in time, be able to solve the issue.

“I guess it’s not good to know everybody has these problems,” Hughes said. “But at least, you know, with all these people gathering together to fight it together, it’s comforting.”

This is a developing story and more will be reported as data becomes available.