Insurer Interference

Patients trust that their health plan will provide them access to physicians and health care facilities in their area, but too often, their plan comes up short. Two-thirds of the country’s population is covered by private health insurance, yet the coverage provided is less and less meaningful. The College of American Pathologists (CAP) believes it should be up to the patient and their doctor – not corporations – to determine where diagnostic services occur, with the goal of delivering the healthiest outcome.

In our latest report, Examining the State of Health Care’s Private Payers and the Adverse Impact of Insurance Interference, the CAP identifies four distinct but related categories illustrating how insurers interfere with physician services and patient care at the local level, including network manipulation and restricting patient care through prior authorization and other utilization management measures.

Pathologists are guiding hospitals and health systems to make decisions that ensure testing and diagnostic accuracy, improve patient care for better patient outcomes, mitigate risks, and ensure quality. The CAP continues to champion pathologists and the valuable care they provide for patients and advocates for the adoption of proposals that protect coordinated care delivery in the best interests of patients, not insurers.