Denial of Health Insurance Claims: A Look into American Health Insurance by Branden Williams

This summer I learned a lot about the health insurance industry and healthcare in the United States as a whole. In the beginning of this year we came up with the hypothesis that health insurance companies profit off of claim denials. What was thought to be a straightforward research question turned out to be the complete opposite. I can only describe the findings as awful as I read and gathered information, there was in fact no light at the end of the tunnel.

We knew that there was one dataset that we had access to, but research had already been done on it. My portion of the project consisted of information gathering. So I naturally started where I believe anyone should start. How did we get to where we are today?

After I answered that question I wanted to get back to our hypothesis. So I started to look for the data. While doing this I found several news articles that had heartbreaking stories. It seemed like for every search there was another awful story. The worst thing about some of these stories was that they resulted in unneeded deaths of people. It was terrible to read because it just felt like they were powerless, and all they could do was accept the situation even if they were going to die.

We got stuck several times trying to access the data that we needed. We would later find out that it was because of the fact that the companies only publicize data if required to do so. Eventually while we didn’t have strong evidence for our hypothesis there was a weak connection between the cost of a procedure and claim denials. The strongest connection within our data was the connection between the amount of processing days and the cost of the procedure. Our data was very limited so there is no way to draw a complete conclusion from what we had found.

Within our field I learned that United States healthcare is very intricate and that the system in place seems to be very hard to navigate and to find any information. We learned that there is very little transparency. If you want to know something you would have to go through many hoops to get that information most of the time. I learned that the research process can be taxing in its own way and that it has a lot of dead ends. What I mean by that is that you find something that you think could be big – only for it to not yield any results. This can take a toll when it keeps happening. We want to change this for the better and call for better transparency not just from the insurance company but from the healthcare industry as a whole.

This happened quite a bit when we were trying to find useful data in order to run analysis. We thought that we found something only for it to not be in a usable form. We also couldn’t find a lot in general due to the fact that a lot of what we wanted was not public information. This was a consistent problem across the entire project. In order to overcome the obstacles we just kept on pushing until we found data that worked for us. We did have to combine multiple sources of data for it to work, but we got something that we could analyze through perseverance. 

From my experience I have learned that there is always a way to find the data that you want. You might have to look through different avenues or collect the data yourself through surveys. One thing is for sure – it is out there; you just have to find a way to get it.

I am going to use the strategies that I have learned during this undergraduate research project and apply it to my professional life. I believe that some of the skills I learned are time management, information gathering in a more efficient manner, and controlling burn out. I understand that burn out can happen very easily if I don’t pace myself, and I now know what an acceptable pace for myself is. My advice to anyone doing undergraduate research would be what I heard at a workshop, “The you of today doesn’t know how the you of tomorrow will be or even the you of next week” That paraphrased quote will stick with me for the rest of my life because I believe that is amazing advice!

Learn more about the Research & Creative Projects for Undergrads at UW Bothell.