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3. 2023 Extension Risk Management Education National Conference

Protecting Health and Financial Well-Being in the Agricultural Community: Managing and Resolving Health Insurance Disputes

Dorothy Nuckols, Catherine Sorenson, Lisa McCoy, and Jesse Ketterman

Summary

A major risk for agriculture workers is illness or injury, with associated medical expenses. Health insurance coverage indicates how much health-related financial risk a household bears. Yet, health insurance companies deny 14 - 18 percent of in-network claims. The Affordable Care Act (ACA) requires that consumers have the right to appeal denied claims. However, health insurance is complex, and consumers often struggle to understand it. Patients with lower health insurance literacy avoid both nonpreventive and preventive services at greater rates, despite cost exemptions for the latter, and are more likely to suffer financial harm. The agriculture industry has a high component of health insurance consumers who are categorized as vulnerable due to language, economic, and other social barriers. These individuals have the highest risk of exposure to unresolved conflict and resulting financial loss. Our needs assessment research found that 32 percent of respondents from the general population have had to appeal a health insurance coverage decision, and over half have needed to dispute a health care billing amount. This is therefore a problem likely to affect clients of Extension educators. Therefore, Extension educators created a plain language consumer education program along with a graphic Health Insurance Claim Navigation Tool to promote awareness and build confidence in health insurance claim navigation. This session will introduce participants to the program, materials, and tool. Program evaluation data show that consumers showed a statistically significant (p<.001) increase in all measures including knowledge of healthcare billing, insurance appeals processes and claims and confidence to manage and solve disputes.

References:

Adepoju, O., Mask, A., & McLeod, A. (2019). Factors associated with health insurance literacy: Proficiency in finding, selecting, and making appropriate decisions. Journal of Healthcare Management / American College of Healthcare Executives, 64(2), 79-89. doi:10.1097/JHM-D-18-00021

Pollitz, K. (2021) Consumer Appeal Rights in Private Health Coverage. Kaiser Family Foundation. https://www.kff.org/private-insurance/issue-brief/consumer-appeal-rights-in-private-health-coverage/

Pollitz, K., and Rae, M. (2022) Claims Denials and Appeals in ACA Marketplace Plans in 2020. Kaiser Family Foundation. https://www.kff.org/private-insurance/issue-brief/claims-denials-and-appeals-in-aca-marketplace-plans/

Teremetskyi, V., Duliba, Y., Drozdova, O., Zhukovska, L., Sivash, O., & Dziuba, I. (2021). ACCESS TO JUSTICE AND LEGAL AID FOR VULNERABLE GROUPS: NEW CHALLENGES CAUSED BY THE COVID-19 PANDEMIC. Journal of Legal, Ethical and Regulatory Issues, 24, 1-11

Tipirneni, R., Politi, M. C., Kullgren, J. T., Kieffer, E. C., Goold, S. D., & Scherer, A. M. (2018). Association between health insurance literacy and avoidance of health care services owing to cost. JAMA Network Open, 1(7), e184796-e184796. https://doi.org/10.1001/jamanetworkopen.2018.4796

USDA (2021) Farm Household Well-being: Health Insurance Coverage. https://www.ers.usda.gov/topics/farm-economy/farm-household-well-being/health-insurance-coverage/

Details

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