Utilization Management
When Insurance Companies Decide Instead of Doctors
Utilization management was introduced to control healthcare costs, but today it’s holding patients hostage in a system that values red tape over essential care. These practices grant insurance companies – not doctors – the power to make critical decisions about patient care.
THE FACTS
15-20% of initial insurance claims in the U.S. are denied.
850 million claims are denied annually.
DELAYS, RESTRICTIONS, AND DENIALS
Instead of trusting healthcare professionals to provide timely, medically-sound care, insurers impose hurdles like prior authorizations, retroactive denials, step therapy, quantity limits, and medical necessity reviews – forcing harmful delays and restrictions, creating confusion for patients, and sometimes denying care altogether.
WHY THIS MATTERS TO YOU
These practices aren’t just frustrating, they’re dangerous. Patients are left in limbo, forced to navigate a system designed to limit access rather than provide care, damaging both their physical health and financial well-being. The current system is working against patients when they need help the most.
Fix the Broken System
This can’t continue any longer. Lawmakers, healthcare providers, and insurers must work together to remove barriers between patients and their care. It’s time to put patients first and heal the system. The solutions are clear:
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Streamline prior authorizations and approval processes to prevent unnecessary delays in care and administrative burdens.
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End retroactive denials. If treatment is approved, insurers should be held accountable to honor their commitment and cover the costs, reducing financial uncertainty for patients.
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Protect physician autonomy. Every patient deserves care that is based on a healthcare professional’s assessment of their medical needs, not on a system that prioritizes the bottom line.
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Remove barriers to emergency care. In emergencies, every second counts. Insurance approvals should never stand in the way of urgent medical treatment.
A Better Healthcare Future for North Carolina.
Join Us in the Fight for Healthcare Transparency.
We invite policymakers, business leaders, advocacy groups, and engaged citizens to join us in demanding a fairer healthcare system. Together, we can shift the conversation, hold insurance companies accountable, and drive meaningful change in North Carolina.