Minorities face denied claims and excessive charges for care that should have been free

Bias in health care: ©Wladimir1804 - stock.adobe.com

Despite the Affordable Care Act's (ACA) mandate for free preventive health care, many Americans are facing denied claims and unexpected bills for services that should be fully covered. A study published in JAMA Network Open highlights that these denials disproportionately affect racial and ethnic minorities, as well as low-income groups, exacerbating health disparities in the U.S.

The study, led by researchers from the University of Massachusetts Amherst and the University of Toronto, examined over 2.5 million preventive care claims between 2017 and 2020. Services such as cancer, diabetes, and depression screenings, along with wellness visits and contraception administration, were analyzed. Researchers found that patients from minority racial backgrounds and lower-income households were significantly more likely to have their claims denied, compared to non-Hispanic white patients and those with higher incomes.

“This research highlights the barriers that certain groups face when trying to access preventive care, which is essential for maintaining population health,” said Michal Horný, co-author of the study and assistant professor at UMass Amherst, in a statement. “Even though the ACA mandates free access to these services, inequities remain at the starting line, particularly for minority and disadvantaged populations.”

Disparities in claim denials and charges

The study found that Asian, Hispanic, and non-Hispanic Black patients were about twice as likely to experience claim denials compared to their non-Hispanic white counterparts. Additionally, lower-income patients were 43% more likely to have their claims denied than higher-income patients.

When claims were denied, health care providers tended to charge more for these services among disadvantaged groups. For example, patients from households earning less than $30,000 were billed a median of $412 for denied claims, while those from households earning over $100,000 faced a median charge of $365.

“These findings demonstrate that the experiences of patients seeking free preventive care differ significantly based on their demographics, which can lead to inequities in accessing these vital services,” the researchers concluded.

Implications for patient care

A related study, published in the American Journal of Preventive Medicine, revealed that 40% of privately insured patients faced out-of-pocket costs for preventive services that should have been fully covered. Such costs may deter individuals from pursuing future preventive care, the researchers warned.

The team examined national data on seven key preventive services, including wellness visits, cancer screenings, and cholesterol checks, all of which are recommended by the U.S. Preventive Services Task Force and covered under the ACA. They found that out-of-pocket costs for these services varied widely based on patient demographics. For example, lower-educated patients were 9.4% more likely to face unexpected expenses than those with college degrees.

“The lack of standardization in how preventive care is billed and covered by insurers creates confusion and inequities,” Horný said. “This adds to the financial burden for marginalized groups, making it harder for them to access care that could ultimately save lives and reduce healthcare costs in the long run.”

Moving forward

Both studies call for greater attention to the gaps in preventive healthcare coverage and billing practices. Without standardized approaches, the researchers say, inequities in access to preventive care will persist, furthering existing health disparities.

“The goal is to prevent diseases before they occur,” Horný said. “Improving access to preventive care not only leads to a healthier population, but it also saves healthcare costs down the road.”

Researchers say for health care providers, these findings underscore the importance of advocating for their patients and working to ensure that all patients—regardless of race, ethnicity, or income—have equitable access to preventive services. These studies also suggest that physicians should be aware of the billing disparities that may affect their patients and work towards more transparent communication about costs and coverage.