Erin Massey is busy in her day job as a scientist at a biotech company. But recently, she’s had another job, too: trying to convince her insurer, Cigna, to pay for a medication that she needs for her insomnia.
Premera, Massey’s previous insurer through another employer, covered the medication, and her doctor has deemed it medically necessary and has filled out numerous forms saying so. But Cigna repeatedly denied her requests for the insurance company to cover the medication, Quviviq, she says.
Massey estimates that she spends 8-10 hours a week working on getting the medication covered: talking to Cigna representatives, filling out forms, writing appeals, and otherwise researching how to convince Cigna that the medication is essential for her health. Her experience is not unusual: in total, Americans spend at least 12 million hours a week calling their health insurance company, according to a Gallup poll.
They do this because of the complicated nature of the American health care system, which often requires pre-authorizations for procedures—essentially a green light from the insurer deeming the procedure medically necessary and covered by insurance—that frequently ends up in denials for care. About 45% of insured working-age adults received a medical bill or were charged a copayment for a service in the past year that they thought should have been free or covered by insurance, according to a 2024 Commonwealth Fund study. And 17% of adults were, like Massey, denied coverage for care recommended by a doctor.
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As a result, people have to pick up the phone and argue with their insurance companies, write letters of appeal, and otherwise spend countless hours tracking the status of their claim. This time suck, dubbed a “time tax” by Atlantic journalist Annie Lowredy, and bureaucratic “sludge” by Stanford professor Jeffrey Pfeffer, is bad for the economy overall and bad for our health.
We may now be spending even more time on this sludge than in the past. News stories suggest that insurers are “becoming increasingly adept” at using technology to deny payment of claims, says Sara R. Collins, one of the authors of the Commonwealth study. “It’s really frustrating for people to pay their premiums and then not get the care they need when they need it,” she says. This undermines people’s trust in the health care system and makes them less likely to seek out medical care, she says.
One study published in JAMA Network Open found that 22% of cancer patients didn’t get the care their doctors prescribed because of delays in prior authorization and other administrative issues.
Cigna told TIME that it is not able to comment on any member’s case without a signed HIPAA waiver. But Massey said that after TIME contacted Cigna about her case, she got an email stating that the original decision denying her medicine was overturned and also that Cigna notified her doctor she would be covering the medication. Cigna said, in a statement, that “we don’t want anyone spending hours on the phone working to understand their benefits or to resolve issues” and that it recently launched an initiative designed to simplify its processes.
Having an insurance company reverse a member’s denial after media or social-media attention is a documented phenomenon. Not everybody can rely on a reporter’s inquiries to overturn their insurance denials, though.
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This health care time tax also costs a lot of money in lost productivity. Pfeffer, of Stanford, estimates that the cost of the time spent by employees dealing with their health insurance companies is around $21.57 billion each year. They often spend time they would otherwise be working dealing with their insurance companies—often because the only time they can talk to claims administrators is during normal business hours.
Because health insurance is frequently a benefit administered by employers, employees sometimes become more frustrated with their company when their insurance doesn’t work as it should. Pfeffer says that people who spend more time on the phone with their health insurer are likely to be less satisfied with their current workplace, more likely to have missed a day or more of work, and more likely to feel burned out at work than people who aren’t having insurance issues. The cost of that reduced satisfaction on their productivity is around $95.6 billion, he says.
Despite the high cost of the health insurance time tax, there are few solutions in the pipeline. The No Surprises Act, which went into effect on Jan 1, 2022, aimed to reduce time patients spent on the phone with their health insurers by protecting them from being billed for out-of-network costs in an emergency. And the Affordable Care Act has some guidelines about what insurers must cover.
But there are few national rules governing insurers’ response times or even requiring them to show how often they deny claims or mis-process paperwork.
Pfeffer says it’s time for employers to start being more proactive and holding insurers accountable for wasting their employees’ time. They hire the insurers, after all, to provide a benefit to their employees, but the benefit isn’t actually always very useful to the employee. Once employers start forcing insurers to show their claim-denial rates or how often their decisions are appealed, he says, insurers may start behaving better.
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“Your employer hires your insurance company, and so your employer should say to the insurance company, ‘We’re going to hold you to a set of performance standards,’” he says. “‘And if you don’t meet our performance standards, we’re going to fire you.’”
Erin Massey has gotten a crash course in how to deal with insurers; she’s learned not to let representatives cut off a call until her questions have been answered, for example, and she demands everything in writing.
She’d been looking for a cure for her insomnia for eight years, doing a lot of trial and error with doctors until she finally landed on the right medication, so it was especially frustrating that Cigna repeatedly denied it.
Until Cigna suddenly reversed course, her next step was to file an external appeal so outside doctors could review her case. At the time, she figured her insurer probably didn’t expect her to get that far. A few hundred hours ago, she wouldn’t have expected to get that far either.
“I have spent entire days just trying to figure out what the next step is,” she says. “It’s been a lot of work.”
