The Deadly Delays of US Health Insurance—and the Ripple Effect on Every Corner of Healthcare
The Deadly Delays of US Health Insurance—and the Ripple Effect on Every Corner of Healthcare
Introduction
In the United States, healthcare providers—from primary care doctors to mental health therapists—are increasingly at the mercy of insurance companies’ restrictive policies, slow reimbursements, and profit-focused tactics. This post is inspired by recent events and reporting (including the tragic shooting of a major insurance CEO and firsthand testimonies from doctors) highlighting the deep flaws in the US healthcare system. But the issues go beyond the stories you see in the headlines: they’re also forcing private practices of all sizes, disciplines, and specialties to close their doors.
The Crisis of Delays and Denials
Physicians and other providers have long warned of a problem that is steadily growing worse: health insurers frequently delay or deny coverage for critical tests, procedures, and medications. These denials sometimes go through time-consuming “peer-to-peer” reviews, where an insurance agent with little or no specialty experience can veto or delay the recommendations of highly trained clinicians. The ripple effect can be catastrophic:
Critical Scans Denied: One doctor recounted how a PET scan approval for a cancer patient took six months to get through. By the time the insurer reversed the denial, the patient had died.
Peer-to-Peer Mismatches: “Peers” evaluating treatment decisions often don’t share the clinician’s specialty. In some cases, internal medicine doctors are second-guessed by junior reviewers who may not fully grasp the urgency of a complex condition.
Maximizing Profits Over Patient Care: As one physician bluntly put it: the moment an insurer receives premiums, every claim for care becomes an “expense” they’d rather avoid—leading to tactics like stalling and dragging out approvals.
Where It Hurts Most: Smaller and Non-Physician Practices
While the headlines often focus on hospitals and large medical groups, smaller offices and non-physician practitioners often face even tougher consequences:
Nurse Practitioner (ARNP) and Physician Assistant (PA) Clinics
Independent ARNP/PA practices rely heavily on prompt reimbursements because they often have slim margins. When insurance companies delay payments or repeatedly deny claims, these practices can’t cover overhead expenses like rent, staff salaries, and medical supplies.
Some have had to reduce operating hours or close satellite offices, leaving entire communities without essential primary care services.
Mental Health Clinics
Therapists and counselors frequently battle insurance denials for longer-term mental health treatment plans. While insurers may cover a few sessions, ongoing therapy—especially for severe depression, PTSD, or other chronic conditions—often hits a coverage wall.
Psychiatrists often face hurdles prescribing newer, more effective medications. Coverage may be refused in favor of cheaper alternatives, delaying recovery for vulnerable patients and placing a massive administrative burden on mental health clinics.
Many small counseling offices have shut down when reimbursements for mental health treatments were cut or delayed, leaving patients with fewer local options for care.
Physical Therapy Offices
Physical therapists help patients recover from surgeries, strokes, accidents, or chronic conditions. Yet insurers frequently limit the number of sessions they will cover, even when a patient’s progress depends on consistent therapy.
Lower reimbursement rates for physical therapy compared to physician services can make running an independent clinic untenable. Providers who spend significant time fighting claim denials can’t recoup the administrative costs, ultimately leading some practices to close.
Rural and Community-Based Practices
Rural health clinics already face geographic and resource challenges. When reimbursements are slow or rates are cut, these small community clinics quickly become financially unsustainable.
The closure of rural practices can have an outsized impact: traveling to the next closest facility (often hours away) may be impossible for elderly or low-income patients.
Why Delays and Denials Force Offices to Close
High Administrative Overhead: Constant appeals, phone calls, and paperwork drain time and money. Smaller offices don’t have the budget to hire staff dedicated solely to the insurance battle.
Decreased Reimbursement Rates: When insurers continually reduce how much they will pay for a procedure or therapy session, clinics can no longer afford to provide those services—especially if they have to invest in specialized equipment or additional staffing.
Cash Flow Crunch: Healthcare providers typically wait weeks or months for payment. A series of delayed reimbursements can deplete a practice’s operating funds quickly.
The Human Toll
Patients Lose Access: When a mental health clinic shuts down, patients in therapy may be left without crucial support. When a physical therapy office closes, post-operative patients may regress without timely care.
Provider Burnout and Shortages: Providers forced to fight for every claim suffer burnout at higher rates. Some quit healthcare altogether or move into salaried positions—leaving communities without an independent resource.
Worsening Health Outcomes: Without accessible clinics, patients may skip preventative care or necessary treatments. This leads to more emergency room visits and higher costs downstream—a vicious cycle.
Calls for Systemic Change
From physicians to ARNPs, PAs, physical therapists, and mental health counselors, many are calling for a fundamental restructuring of the healthcare system. Suggestions often include:
Single-Payer or Universal Healthcare Models
Drawing on the experience of many industrialized nations, proponents argue that a single-payer system could vastly simplify billing, ensure consistent payments, and improve patient outcomes.
Stricter Regulation of Private Insurers
Some believe more robust oversight—standardizing reimbursement timelines, capping profit margins, and penalizing unwarranted denials—could alleviate the worst issues in private insurance.
Greater Investment in Preventative Care
If reimbursements for preventative and early-intervention services are improved, it could cut overall costs and reduce the burden of advanced diseases.
Conclusion
The Guardian’s reporting sheds a harsh light on how insurance companies’ profit-oriented strategies harm patients’ lives. Yet the damage doesn’t stop at hospitals or specialists. Every corner of the healthcare ecosystem—nurse practitioners, physician assistants, mental health providers, physical therapists, and beyond—shares the burden. Clinics are closing, care is delayed or denied, and patients in need are left behind.
Reforming a system as vast and deeply entrenched as American healthcare won’t be easy. Still, the very real stories of practitioners who can no longer sustain their offices—and the patients who have lost local access to lifesaving services—underline the urgency. Whether through a single-payer approach or through strong regulation, it’s clear that protecting both patient care and the viability of smaller practices is vital for the overall health of our communities. Marie Matteson, MS
Thank you for reading. If you have insights or personal experiences related to insurance delays or practice closures, I encourage you to share them—together, we can paint a fuller picture of this crisis and advocate for transformative solutions.
