Wisconsin Patients
and Hospitals  

Wisconsin Patients
and Hospitals  

The Problem:

What’s driving up the cost of healthcare?

Healthcare insurance costs, inadequate coverage and excessive administrative demands are creating a no-win situation for patients and hospitals. Patients are stuck with increasing premiums yet unhealthy denials or delays in coverage. Hospitals are stuck providing care for uninsured or underinsured people and a costly administrative burden for prior authorizations and delays in coverage.

Meanwhile, insurance companies are blaming Wisconsin hospitals for rising costs and coverage gaps. Let’s end the misinformation. Hospitals are not the reason for: 

  • Escalating healthcare insurance red tape and administrative costs 
  • Increasing denial and delay of patient coverage 
  • Decreasing access to appropriate care providers 

The primary driver of rising costs and inadequate coverage is big insurance and their cohorts, including big pharma, PBMs and drug distributors. Despite intensive lobbying to cast blame on hospitals and patients, data and facts are not on the side of major insurance companies.  

Of physicians reported prior authorization always, often or sometimes delays patients’ accessing necessary care.1
Of physicians report a negative impact on patient clinical outcomes due to prior authorizations.2
Of U.S. healthcare costs reflects the combined revenue of the nine biggest insurers, drug distributors and PBMs.3
Of Wisconsin hospitals are nonprofit organizations providing valuable services on shoestring budgets.4 
Of patients think there should be more transparency from insurance companies on prior authorization criteria.4 
Of patients say policymakers should crack down on insurance company practices that delay or deny care.4
Of patients want their healthcare provider to determine their care, not insurance companies.4
Of patients who feel they pay too much for healthcare blame insurance coverage for the high costs.4

What people are saying about Wisconsin healthcare costs & access

“This (alternative funders) is a shell game. You have insurance. You think it should pay for your biologic. Now you’re being told there’s no coverage. There’s a lot of bumps in the road there and myriad opportunities for patients to drop off treatment.”
Christopher Phillips, MD, Paducah, KY

“Emerging evidence shows that insurers use automated decision-making systems to create systematic batch denials with little or no human review, placing barriers between patients and necessary medical care. said in a Monday release. Medical decisions must be made by physicians and their patients without interference from unregulated and unsupervised AI technology.”
Bruce Scott, M.D., President, American Medical Association

“I feel like I’m stuck in the middle because the insurance companies may only approve certain things, and the doctors want me to see certain specialists or do certain things [to stay alive]. It’s so stressful when you have a condition and you need medicine, you need care. But it’s not the doctors and the referrals. The insurance should go through without all these issues.” 
Darrell, Shullsburg, WI 

“When it comes to insurance companies and referrals or (prior) authorizations, my referral team fights with them all day, every day, I’ve seen patients who might need a transplant or something to save their lives and the insurance company says, ‘It’s not medically necessary.’ How is it their right to say, when it’s to save your life, ‘It’s not medically necessary?” 
Amy Foley, Patient Access Manager, Major WI Healthcare Provider

“[Prior authorizations] also put patients in the middle, sometimes asking them to switch from their preferred location and interrupting continuity of care.” 
UW Health, Wisconsin
Healthcare Financial Management Magazine, 2021

“Insurance companies hurt hospitals and patients by delaying and denying care.” 
Lou Kowieski, Oconomowoc | gmtoday.com

“Insurance companies pad their profits by delaying and denying care, hurting both patients and hospitals.” 
Laura Welch, Wisconsin State Journal

Let’s Hold Insurers Accountable 

There’s much to be done to release patients and hospitals from the disastrous health and financial consequences of big insurance company practices.  

  • Stay informed about the impact of big insurance on costs and coverage. 
  • Demand increased transparency in the insurance industry.
  • Encourage legislative and regulatory reforms that protect patients and streamline administrative tasks.
  • Ensure more resources are directed toward patient care, not bureaucracy.
Graphic of doctor on phone, tangled thought bubble above head

In The News

View More News
Download Our Whitepaper