The one thing 116 healthcare providers would change about health insurance [verbatim]

In their own words, providers say health insurance companies deny treatments they’ve prescribed to patients too often – here’s what they would change if they could

by Intelliworx

More than 4 in 10 healthcare providers surveyed have considered quitting their jobs over the burden insurance sometimes places on their daily work. That’s according to a survey of providers we commissioned and published last month.

The findings characterized the frustration providers have with payers over claim denials. It’s a concerning statistic given the prolonged shortage of providers that continues to challenge the healthcare community:

“Given the persistent and prolonged shortage of healthcare talent, this could be an opportunity for savvy employers to stand out among rivals,” said Patrick Youngblood, DBA, SPHR. “Those who are willing and able to find creative solutions to ease the strain providers face in complying with payer demands could be a boost to provider recruiting and retention.”

While we offered several suggestions for healthcare employers to address this issue in the original announcement, one of the best places to start is by simply listening to what providers have to say about it. 

To that end, the final question of our survey asked providers an open-ended question: 

• If you could change one thing about healthcare insurance what would it be?

More than 200 providers took the time to write in answers and are depicted in the nearby word cloud. We’ve gone through all of the responses, removed those that were largely making the same point and grouped what remained into categories. 

(Click for larger image)

 

What 116+ healthcare providers would change about insurance

While we’ve edited some of the responses for typographical errors and clarity, we did so sparingly and without changing the meaning – and kept the emphasis respondents added. 

 

Support provider efforts to diagnose issues:

• “Don’t question testing for possible serious conditions.”
• “[Healthcare should be] “doctor-driven not insurance-driven.”
• [Make] “insurance bosses quit trying to determine patient needs.”
• “Listen to the [medical] professionals and not waste time/money requiring totally unnecessary and pointless treatments. Delays proper care for the patient and costs way more than simply doing what is necessary for the proper treatment.”

 

Cover provider prescribed treatments:

• “Cover procedures that an MD prescribes as medically necessary.”
• “Less persuasion to cover costs.”
• “Cover treatments ordered by the physician.”
• “Deny less things. Trust the doctors more.”
• “Do not deny claims if the patient has the essential requirements.”
• “They would allow prescribers to use their clinical judgment.”
• “They would be more agreeable to what the physician is prescribing to help the patients.”
• “The provider makes the decisions of what is best for the patient, not the insurance company.”
• “To actually pay for medically necessary treatments.”
• “Only qualified medical professionals should decide if insurance will cover.”
• “No pushback from covering certain procedures.”
• “Get rid of insurance interference in decision-making.”
• “Easier coverage for patients that need care.”
• “If a doctor prescribes it, insurance must pay for it.”
• “It would be to never deny a cancer patient the lifesaving treatment they deserve.”
• “Make them pay for what the doctor ordered.”
• “Make them stop thinking they are doctors when they do not know the best treatment for patients.”
• “Non medically trained professionals or AI making decisions about health care an MD/CRNP should be making.”
• “Not let them dictate everything.”
• “Stop acting like doctors.”
• “That it would cover everything – there is not a 1 size fits all for treatment.”
• “That it would cover more things without a headache or hassle.”
• “That the insurance companies let the practitioners decide what their patients need.” 
• “THAT THEY DON’T QUESTION THE DOCTOR WHEN THEY ORDER SOMETHING. THE DOCTOR KNOWS THE PATIENT.” [emphasis theirs]
• “That they pay for what the doctor prescribes to patients without resistance.”
• “The insurance company having anything to do with treatment.”
• “For doctors who have no experience in certain specialties to stop being the ones who determine whether or not a patient is approved for a medication under that specialty.”

 

Address the cost of pharmaceuticals:

• “Delay of RX fills due to pharmacist questions.”
• “Fight the drug companies to not let them charge so much.”
• “Reduce cost for insulin.”
• “Quit denying so many drugs.”
• “The price of medications.”
• “I would get rid of PBM’s and make it so that when a doctor prescribes a medication for a patient, insurance has NO CHOICE but to cover it. A DOCTOR’S order should literally be all that is needed for some uneducated insurance worker to ‘decide’ to cover a medication.” [emphasis theirs]

 

Fix the pre-authorization process:

• “The pre-authorization process is a blockage to providing excellent healthcare. It should be stopped.”
• “The prior authorization process would be easier.”
• “Not having to obtain prior authorization.”
• “No difficulties getting authorizations for things that are truly needed for patients.”
• “Get rid of prior authorizations.” 
• “I would change how hard it is to get prior authorization for treatments”
• “To stop questioning why something is needed. To do away with Prior Authorization on medications, nothing worse than sending a patient home to get a call that their insurance wants approval before they will pay. If something is needed or prescribed, the doctor and team know what is best for the patient.”

 

Improve collaboration among payers, providers and patients:

• [Have] “empathy.”
• [Reduce] “how complex it is.”
• “Less overworking.”
• “Make the process simpler.”
• “Be consistent.”
• “Ease of communication and availability.”
• “Have a realistic approval process.”
• “Easier cooperation.”
• [Make this] “easy to navigate.”
• “Helping patients be able to navigate their own healthcare plans. E.g., if they come to my clinic as opposed to another clinic will they pay more out of pocket even though we take their insurance.”
• [Less] “time to get approval.”

 

A patient-first approach is best:

• “Going back to helping people instead of worrying about the payment first.”
• “How much they [insurance companies] value profits.”
• “Looking at medical facts over huge profit for themselves.”
• “Negotiate profit margin with cost consideration patient care.”
• “I would change how the insurance companies care more about their money than the patient.”
• “I would like to see a governing body oversea what gets approved and what does not instead of letting the insurance companies decide. I would like it to be a third party that is agreed upon.”
• “Have them cover every single medication the patient needs. Having the patient take their prescribed medications will keep them out of the hospital.”
• “That it would provide good coverage for everybody without those being insured needing to appeal denials.”
• “That they support the patient more and spend less time trying to save money.”
• “To make it easier for those in need to receive care and medication that are needed in a timely manner.”

 

Greater emphasis on prevention:

• “That we did more preventative care and insurance paid for it.”
• “They need to cover more preventative visits and medications.”

 

Change the insurance business model:

• “It would no longer be for profit.” (3 respondents said something similar)
• “Get rid of the health insurance industry.”
• “Less control over healthcare decisions.”
• “It’s too pricey for the little it is used when you’re healthy.”
• “Make it actually worth the money.”
• “Put greater checks and balances on insurance companies.”
• “Profit/business model. Money over patients.”
• “By adding discounts and making fair returns [on investment].”

 

Improve affordability:

• “Lower cost.” 
• “Amount of deductible.” 
• “Cheaper for retirees.”
• “Making it more affordable for middle and lower class Americans.” 
• “More affordable and comprehensive.”
• “Make it more affordable.” 
• “The massive deductibles.”
• [Reduce or cut] “copays.” 
• “Not so expensive.”
• “Cheaper medications.”
• “The cost is too high.”
• “The percentage of [annual] rate increase.”
• “The out-of-pocket costs.”
• “The premiums and coverage.”
• “It would be to have the company be more transparent about costs.”

 

Improve healthcare accessibility: 

• “Affordability and accessibility. It’s just not real realistic.” 
• [Provide] “Better coverage.” 
• “Have it cover more things that are essential.”
• “Free health care for everyone” 
• “Make it universal, people shouldn’t have to fight for coverage for things they need.” 
• “I would like it to be more accessible to everyone! I want everyone to have the same opportunities and options to healthcare.”
• “I would change the way people are evaluated for care they deserved.”
• “I would make it so that they would be able to insure more people and wouldn’t have to deny people coverage.”
• “I would change the fact that it is so expensive, and patients often do not get the coverage they rightfully deserve or the treatment they deserve either.”

 

Better coverage without the stress:

• “Cover in the hospital expenses.”
• “Cover more medicine and supplies.”
• “Cover more things without all the stress.”
• “Cover everything.”

 

Eliminate waste, fraud and abuse:

• “Eliminate the wrongdoers and fraud.”
• “Get rid of the loopholes.”
• “Clean house!”
• “I wish people would not abuse the healthcare system so insurance companies were able to do more.”

 

In a category of their own:

• “Get workers back to the office to do their jobs.”
• “I would wish there were auto payments.”
• “Just be generous.”
• “Not so greedy.”
• “That CEOs care more about people than profits!”
• “Shouldn’t be that complicated. Too much profit-focused.”
• “The whole process of insurance is a complete scam.”
• “The hassle of it all.”
• “The confusion.”

* * *

The survey polled 211 U.S.-based healthcare providers between January 30, 2025, and February 4, 2025.  Respondents were solicited through an independent survey panel. A copy of the report is freely available here: Healthcare providers express frustration with payers over denied treatments [survey]. 

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