Letter to CEOs on Biden-Harris Administration’s Time is Money Initiative

Dear CEO,

The Biden-Harris Administration believes all Americans deserve the peace of mind that having health coverage brings. Yet, for far too many, that comfort is undercut by frustrating, confusing, and time-consuming experiences with health coverage that make it harder to access the care they need.

President Biden is committed to addressing those points of aggravation, unnecessary red tape, and unhelpful customer service that waste people’s time and money. We know that you share our goal of minimizing those issues. Unfortunately, too often people experience these pain points when dealing with their health coverage. Individuals can be required to navigate complicated processes to get approval or reimbursement for care, like having to print, manually fill out, and mail paper insurance claim forms even when the technology exists to offer an option to submit these claims electronically. At the same time, many individuals without access to the technology necessary to submit claims electronically may need to submit claims on paper. When people want to reach customer service for help, they can encounter inaccurate or confusing websites, extended wait times, or narrow call center hours that force them to step away from work to talk to an agent. Online websites can also be out-of-date, hard to navigate, and lack critical information about in-network clinicians or facilities, or an individual’s specific coverage, such as current prescription drug formularies. Individuals also find it difficult to understand their rights for appealing coverage denials or errors and where and how to make such appeals.

This frustration is widespread and has serious consequences. A recent survey from the Kaiser Family Foundation found that 58 percent of people with health coverage say they encountered at least one problem using their coverage in the past year, and people with greater healthcare needs – particularly those receiving mental healthcare – were more likely to experience challenges. More than half of people report difficulty understanding at least one aspect of their health coverage. These challenges don’t just add time and frustration to Americans’ daily lives; they can impact decisions people make about when to seek care – or whether they seek it at all.  Among those who had problems with their health coverage in the last year, one in six (17 percent) say they were unable to receive recommended care as a direct result of their problems using their health coverage; 15 percent say they experienced a decline in their health; and about three in ten (28 percent) say they paid more than they expected for care—all as a direct result of their problems with accessing their health coverage.

It should be easy for consumers to use their health coverage. The Biden-Harris Administration is evaluating what actions to take to address pain points across the economy, including those in the health insurance market. We urge you to partner with the Administration on our shared goal by evaluating your operations and protocols and considering what steps you can take to help improve Americans’ experience with your health coverage options. As a leader in the healthcare industry, we challenge you to consider all actions within your purview—not only those mandated by the letter of the law, including those recently enacted. This includes:

• Helping individuals enroll in the right plan by streamlining processes and providing clear, digestible information about health coverage.
• Improving individuals’ ability to submit claims on their own time and on their own terms—including by submitting claims online rather than having to print and mail forms.
• Providing individuals with critical information in clear, accessible language that limits jargon.
• Denying claims only when appropriate, including ensuring that patient care decision support tools (including but not limited to algorithms) and other internal protocols are not misused to deny coverage of necessary care.¹ When an individual’s claim is denied, providing simple, step-by-step instructions on appeals and ensuring the appeals process is minimally burdensome.
• Improving customer service support so that individuals can have questions answered swiftly.  If people want to talk to a customer service agent, they should be able to do so quickly, conveniently, and without long wait times. If individuals prefer to interact electronically – such as by text, email, or online portal – there should be simple and easily identified ways that comply with appropriate federal civil rights and privacy laws.
• Identifying ways to make finding critical information about in-network clinicians and facilities, as well as prescription drug formularies, easier with accurate and user-friendly tools on accessible websites and customer portals.
• Providing information about prior authorization and other medical management rules in clear, accessible language and streamlining these processes where possible.
• Providing critical information in a culturally and linguistically appropriate manner that considers the specific needs of the demographic of individuals in your service area, including people with limited English proficiency and people with disabilities.  Including ensuring compliance with Section 1557 of the Affordable Care Act, which prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in any health program or activity that receives federal financial assistance, State-based health insurance Exchanges, and HHS health programs and activities.² 
• Ensuring compliance with applicable provisions of the Affordable Care Act (ACA) and No Surprises Act (NSA) that are designed to increase transparency and streamline appeals processes, such as the NSA’s price comparison tool and provider directory accuracy provisions, as well as the ACA’s internal claims and appeals process provisions.
• Removing individuals from the middle of surprise billing disputes by following NSA provisions, including appropriately identifying when an out-of-network claim is subject to the NSA and complying with the deadlines for disclosures and payment.

As highlighted above, the Biden-Harris Administration is also committed to taking action. For example, the Centers for Medicare & Medicaid Services (CMS) is ensuring patients get care promptly by cracking down on the inappropriate use of prior authorization, other utilization management processes, and claim denials; by providing information about quality ratings, which include member experience scores,³ for plans on the Marketplace; and by collecting and publishing information on claims denials and appeals for Marketplace plans. We have also continually prioritized improvements to government websites like HealthCare.gov. Additionally, when tens of millions of Americans needed to renew their Medicaid and CHIP coverage after the expiration of the Medicaid continuous enrollment condition under the Families First Coronavirus Response Act, CMS offered significant policy flexibilities to states to streamline the renewal process. CMS worked with states, health plans, providers, community organizations, and federal partners, like the US Digital Service, to help improve auto-renewal rates, fix renewal systems issues, and conduct outreach to people renewing their coverage.

Our Departments intend to assess all available levers to address customer service issues in health coverage that needlessly waste people’s time and money. In addition, our colleagues at the Office of Personnel Management (OPM) will explore ways to leverage their authority to promote similar goals among Federal Employee Health Benefits (FEHB) carriers.

We would like to meet with you to discuss ways we can collaborate to improve Americans' experiences. We look forward to partnering with you in this important work.

Sincerely,
Xavier Becerra
Secretary, U.S. Department of Health and Human Services
Julie A. Su
Acting Secretary, U.S. Department of Labor

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Endnotes

¹  Note that discriminatory use of such tools would violate Federal civil rights laws. HHS recently published a final rule on Section 1557 of the Affordable Care Act that prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in health programs or activities through the use of patient care decision support tools. 45 C.F.R. § 92.210(a). A patient care decision support tool is any automated or non-automated tool, mechanism, method, technology, or combination thereof used by a covered entity to support clinical decision-making in its health programs or activities. 45 C.F.R. § 92.4. The final rule has been challenged in several courts and is not currently in effect in Texas and Montana. Additional information about that final rule is available here: Section 1557 of the Patient Protection and Affordable Care Act | HHS.gov.

²  The Section 1557 Final Rule has been challenged in several courts and is not currently in effect in Texas and Montana. Additional information about the rule is available here: Section 1557 of the Patient Protection and Affordable Care Act | HHS.gov.

³  https://www.healthcare.gov/quality-ratings/