Believe it or not, most people like their health insurance

Andrew Witty, CEO of UnitedHealth Group, is just one among a handful of health care executives speaking out in recent days to acknowledge that America’s health care system needs fixing. Witty is the boss of UnitedHealthcare insurance CEO Brian Thompson, who was shot and killed two weeks ago.

Let’s look more closely now at what Americans say when you ask them how they feel about their health insurance. We know that nationally around 15% of insurance claims are denied, according to the National Association of Insurance Commissioners.

Kaye Pestaina is vice president at the nonprofit KFF, which has done research on this. She recently spoke with “Marketplace Morning Report” host David Brancaccio. Below is an edited transcript of their conversation.

David Brancaccio: Your team did scientific polling on this, and most insured adults give health insurance companies positive ratings. How positive?

Kaye Pestaina: Most folks like their insurance [and] are happy to have it. The issue is, what happens when they have to use it? When you drill down, about 60% of those we surveyed indicated that they had a problem with their health insurance. Most people don’t need acute health care most of the time, which is a good thing — particularly those under 65, those with employer coverage. We always talk about, maybe it’s about 20% of folks who are really spending most money, because they’re the ones who are in need of health care. And so I guess it’s not a surprise that most people are OK with their coverage. Most people aren’t using it, but for those who do and have to use it a lot, that’s where our focus is.

Brancaccio: And so that I’m fully clear, you found, your team found that people in worse health — and I assume needing more health care — have more problems with their insurance when you asked.

Pestaina: Yes, I think that’s the experience of people. For someone who’s having maybe a car accident or a cancer diagnosis or diabetes or mental health, you know, these are episodes of treatment where there’s a lot in coming, lots of bills and insurance information that’s all coming at once, at a time when you’re most vulnerable. And you can imagine the frustration.

Brancaccio: Now, when you step back slightly from this, you’re reminded of just the confounding nature of America’s health care system — where it’s not that someone has just walked into a mall and decided that they wanted to buy that pair of pants, it’s that a professional, a health care provider has said, “You probably need something.” And then the health insurance company says, “Yeah, but we’re not going to pay for it.” Just that contradiction.

Pestaina: It’s a complicated process, and not every claim denial is inappropriate. I mean, some care shouldn’t be covered. But in addition to our consumer survey, part of our research is trying to figure out, what is this claims review process? How is it working? Who’s doing the review? How is it being reviewed? How many denials are there? What claims are being denied for what type of care? What are the reasons? And also, just how fast are those decisions being made? Getting more information about what’s happening in the claims review process on the ground.

Brancaccio: You’d like the providers to tell the patients in advance. But of course, they, in a sense, can’t fully because they don’t know exactly what your insurance company is going to do.

Pestaina: There are definitely some federal reforms and many at the state level that were designed to get folks more information. Some are just not yet implemented. Some consumers are not even aware of [them]. We asked consumers about when it comes to claims, did you know that you can appeal a denial of a claim? Just about every consumer can. It doesn’t matter what kind of coverage they have. And many just weren’t aware there was a process in place to do that. We don’t have transparency. There are some transparency protections as well under federal law, transparency and coverage that were part of the Affordable Care Act that mostly haven’t been implemented. We don’t have a lot of information about the types of care that was denied and why, and you know, more information there as just as an oversight item is probably useful.