How healthcare employers do more to help providers manage payer frustration

Three-quarters of providers say payers deny treatments they prescribe at some point. More importantly, many people show that this is too frequent, taking up too much time, and having a large number of considerations about these engagements will increase the requirements for their jobs.

This is based on a survey conducted by our company through an independent group. We conducted a survey of 211 U.S. providers in January and February this year.

Nearly half of the survey said they spent too much time with insurance companies back and forth to approve the care they prescribe for patients. The time required for remediation claims is the time that the same provider may spend with other patients.

Denied is an increasing concern

Other relevant investigations and studies have produced comparable findings.

For example, a 2024 survey of 200 medical staff responsible for billing found that 73% of people said rejection claims are increasing. Additionally, 67% said it would take longer for the payer to repay the claims that did pass. At least 77% of people don’t care about the claims, including 43% who care very much or are very concerned about it.

Similarly, KFF analyzed data from the Affordable Care Act (ACA) market and found similar results. Payers “reject 19% of in-network claims in 2023, while 37% of online claims make up on average 20% of all claims.”

Why? “The most common reasons cited by insurance companies are 'other', followed by 34%, followed by administrative reasons (18%), exclusion of services (16%), lack of prior authorization or referral (9%), based solely on the lack of medical necessities.”

“My employer can do more”

This alone deserves the attention of healthcare employers, given the adverse impact of renewed efforts on income. But, there is another right reason: recruitment and retention.

In the survey, 44% of healthcare providers who responded considered leaving their own position on the issue. More importantly, about one-third of people have considered quitting at some frequency.

Given the shortage of providers, this is all about statistics. Combining this challenge with burnout that is prevalent throughout the medical community, we can see that potential is snowballing.

Can employers do more to help providers face insurance challenges? Nearly half of the people who were polled believe they can. This includes 36% saying, “My employer is mostly supportive, but can do more” – another 9% saying, “My employer is a little supportive, but can do more.” Finally, four people said, “My employer is not supportive at all.”

What can healthcare employers do?

There are all kinds of systemic problems in our healthcare system – many people go beyond the immediate control of any individual employer. What employers should do is focus on what they can control. One of the best starting points for this is simply listening to the provider’s comments on it. Here are some actionable suggestions.

1. Get a baseline assessment in your organization

We recommend conducting a similar survey of the providers you adopt to obtain a baseline assessment. Seek to know whether it occurs and how often it is. This will provide you with a way to understand the extent of the problem and organizational risks.

It is important that you also want to know how much time the provider has invested in correcting these issues. Quantitative time gives you a sense of estimating the financial impact of indicators such as work relative value units (WRV).

Understand that financial impact has two downstream impacts. First, numbers convey the scope of the problem in business terms that everyone can understand. Second, these costs are effective benchmarks, which may be the basis for future business cases of proposed solutions.

2. See what's being done is different

Not every provider agrees that this is a problem. For example, about 15% of providers we surveyed said that payers “seldom” or “never” deny the claim. Nearly two-tenths of the effort level is correct in terms of the time it takes to meet insurance needs.

These providers may have solutions. Voting is a way to identify them and then find out what they are doing differently.

Use this information to develop best practices that can be shared among teams. For example, are providers who think the time they need on insurance issues reasonable – will they enter better notes – or will the insurers just have overly fanatical expectations?

3. Make it part of the onboarding and exit interviews

The potential impact on HR means that it is crucial to deal with payer challenges during the onboarding and exit interviews. When you have a provider take leave, it is an opportunity to get candid feedback on how the organization can better address insurance needs for its provider.

Similarly, when your organization is on the board is a newly hired provider, use what you have learned to provide new employees for success.

“Best for patients”

The last question of the survey asked the provider an open-ended question: If you could change one thing about Medicare, what would it be?

More than 200 providers provide their written ideas. The vast majority of people think that what they think is the insurance company's guess is their medical decision.

One respondent wrote in a representative answer: “Provider decisions are best for patients, not those of the insurer.”

Indeed, the best interest of patients is why many providers are engaged in medical professions and perhaps the reasons why they stay. Insurance needs are often more about management than medicine. This is a good reason why healthcare employers do more and more to help providers get frustrated with payers.

Photo: Pixelliebe, Getty Images

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