Survey: Characteristics of consumers who report problems with Prior Authorization

A new survey by the Kaiser Family Foundation (KFF) reveals how insured adults rate their health insurance and what problems they face using their coverage. The survey, conducted in June, interviewed more than 2,000 adults who have health insurance through Medicare, Medicaid, employer-sponsored plans (ESI), or Affordable Care Act (ACA) Marketplace plans.

Key findings

• Most insured adults (81%) give their health insurance a positive rating of “excellent” or “good”, but ratings vary by health status and insurance type. Adults in fair or poor physical or mental health are more likely to rate their insurance negatively than those in good or better health. Adults on Medicare are more likely to rate their insurance positively than those on other types of insurance, while those on Marketplace plans are more likely to rate their insurance negatively.
• Most insured adults (58%) say they have experienced a problem with their health insurance in the past year, such as denied claims, provider network issues, and prior authorization hassles. Problems are more common among adults in fair or poor health, those who received mental health care or used a lot of health care, and those on Marketplace or Medicaid plans. Only half of those who had problems say they were resolved to their satisfaction.
• Some insured adults report dire consequences because of their insurance problems. Among those who had problems, 17% say they were unable to receive recommended care, 15% say they experienced a decline in their health, and 28% say they paid more than they expected for care.
• Many insured adults who have mental health needs say they did not get the care they needed or that their insurance did not cover it. Among those who report being in fair or poor mental health, 43% say they did not get mental health services or medication they needed in the past year, 45% give their insurance a negative rating on the availability of mental health providers, and 19% say their insurance did not cover a particular mental health service or treatment they needed. Adults on Medicare are less likely to report these issues than those on other types of insurance, while those on Marketplace or Medicaid plans are more likely to report them.
• Affordability of premiums and out-of-pocket costs is a concern for many insured adults, especially those with private coverage. About half of adults with Marketplace plans (55%) or ESI (46%) rate their insurance negatively on premiums, compared to 27% of those with Medicare and 10% of those with Medicaid.