Hoosiers Face Rising Health Insurance Premiums as Hospitals Are Left Unpaid

A new Payor Scorecard, analyzing data from 70 Indiana hospitals, shows hospitals delivered more than $717 million in care in 2025 that went unpaid as insurers delayed or denied payments—while continuing to raise premiums and out-of-pocket costs for Hoosiers.

The Indiana Hospital Association (IHA) estimates that if all Indiana hospitals were included in the dataset, total unpaid care would exceed $1.6 billion statewide. The findings reveal a widening gap between what insurers collect from patients and employers, and what hospitals are ultimately paid for care delivered.

“Hoosiers are paying more every year for health insurance, so the question is simple: where is that money going?” said IHA President Scott B. Tittle. “Insurers are shifting more costs onto patients through higher premiums, deductibles, and coinsurance, while also delaying and denying payments they already agreed to make to hospitals. That combination creates real barriers to care and financial stress for Hoosier families and our health care system.”

What the data shows

The Payor Scorecard analyzes hospital and physician billing and payment data to show how insurer practices affect patients and providers after care has been delivered, highlighting payment trends, denial patterns, and insurer behavior that threaten patient access and hospital sustainability. Produced by Kodiak Solutions, the scorecard uses Kodiak’s advanced revenue cycle analytics and national benchmarking database—covering more than 2,300 hospitals—to compare payor performance across plans over time in Indiana and nationwide.

Key findings for Indiana in 2025:

• $717 million in lost hospital revenue due to claim denials and bad debt write-offs—money hospitals were contractually owed for covered care but never received.
• Nearly 13% of dollars billed to insurers were initially denied, representing $4.7 billion in delayed payments to hospitals.
• According to Kodiak, more than 80% of those denials were ultimately overturned, but hospitals still had to spend significant time and money resubmitting and appealing claims to receive payment.
• More than one-third of denials—totaling $1.8 billion—were driven by requests for additional information, even when care was appropriate and properly delivered.
• On average, hospitals waited 46 days to receive payment from insurers after care was delivered. Nearly 30% of insurer payments were delayed more than 90 days.
• Commercial insurers took three times longer to pay for care than traditional Medicare, straining hospital cash flow.
• Medicare Advantage plans denied payments at roughly three times the rate of traditional Medicare, demonstrating a clear trend in insurer behavior.
• In 2025 alone, Indiana hospitals spent over $400 million pursuing payments insurers owed for care already delivered.
• Commercial insurers are shifting a larger share of costs onto Hoosier patients and providers while reducing what insurers ultimately pay.
  • In 2025, nearly 25% of the allowable amount on commercial claims—the maximum amount a health insurance company will pay for a covered service—was attributed to patient responsibility, exceeding the national average.
  • When patients are unable to cover those growing out-of-pocket costs, Indiana hospitals are left absorbing the cost of care provided but are never fully reimbursed. This leads to significant increases in bad debt. In fact, bad debt for Indiana hospitals rose nearly $270 million from 2024 to 2025.

“What we’re seeing in Indiana mirrors national trends—higher denial rates, longer payment delays, and more administrative barriers after care has been delivered,” said Matt Szaflarski, vice president of revenue cycle intelligence at Kodiak Solutions. “The data shows these practices aren’t isolated incidents. They’re becoming standard operating behavior across many commercial and Medicare Advantage plans, creating downstream impacts for patients and providers alike.”

Hospital prices decline as patient costs rise

The Scorecard findings come at a time when Indiana hospitals have reduced prices. In 2024, all five of Indiana’s largest hospital systems lowered prices, according to a State-commissioned study, and national rankings show Indiana hospitals continue to make care more affordable for Hoosiers.

Despite these declines in hospital prices, patients are facing higher insurance premiums and rising out-of-pocket costs. Employer-sponsored health insurance premiums continue to rise in Indiana and nationally, affecting individuals, families, and employers across the state.

The impact on Hoosiers

As insurance companies raise premiums, deductibles, and coinsurance, they are paying less while Hoosier patients pay more.

That results in:

• Financial stress for families facing higher out-of-pocket costs
• Delays in care as claims are denied, disputed, or reprocessed
• A growing burden of unpaid care absorbed by hospitals—costs that ripple through the entire health care system and raise costs for all Hoosiers

“In simple terms, insurers are collecting premiums but not reliably paying for care,” said Tittle. “This is the hidden cost of insurance—more paperwork, more waiting, and more financial uncertainty for Hoosier families.”

Holding insurers accountable

IHA is releasing the Scorecard as part of its Access Denied effort to expose harmful insurer practices and elevate patient voices. Hoosiers can share how insurer practices delay or deny care—and urge policymakers to take action.

To learn more or share your story, visit AccessDeniedIN.org.

“If we want to lower health care costs and protect access to care, insurers must be held accountable for the promises they make,” said Tittle.