Which Insurer Denies the Most Claims?
According to the 2008 Health Insurance Report Card (PDF) released by the American Medical Association, the “carrier” with the highest percentage of denials is . . . Medicare. Does it still sound like we need to put the government in control of (or develop a public option to compete with) health insurance companies to prevent them from denying claims?
| Metric 12—Percentages of claim lines (i.e., records) denied
Description: What percentage of records submitted are denied by the payer for reasons other than a claim edit? A denial is defined as: allowed amount equal to the billed charge and the payment equals $0. Source: NHXS |
||||
|
Payer |
Count of records |
Denied records |
Percent of claim lines denied |
Date range |
| Aetna |
637,239 |
43,317 |
6.80% |
03/01/2007 – 3/10/2008 |
| Anthem |
250,070 |
11,546 |
4.62% |
03/01/2007 – 3/10/2008 |
| CIGNA |
263,728 |
9,060 |
3.44% |
03/01/2007 – 3/10/2008 |
| Coventry |
20,487 |
590 |
2.88% |
03/01/2007 – 3/10/2008 |
| Health Net |
4,975 |
193 |
3.88% |
03/01/2007 – 3/10/2008 |
| Humana |
143,026 |
4,142 |
2.90% |
03/01/2007 – 3/10/2008 |
| Medicare |
6,938,431 |
475,566 |
6.85% |
03/01/2007 – 3/10/2008 |
| UHC |
1,127,691 |
30,177 |
2.68% |
03/01/2007 – 3/10/2008 |
13 Responses to “Which Insurer Denies the Most Claims?”
Leave a Reply
| Marc Kilmer Maryland Public Policy Institute View Posts |  |
| Beverly Gossage Show-Me Institute View Posts |  |
| Sally Pipes Pacific Research Institute View Posts |  |
| Donald R May Surgeon View Posts |  |
| Joseph D. Coletti John Locke Foundation View Posts |  |
| John LaPlante The Prometheus Institute View Posts |  |
| Peter Nelson Center of the American Experiment View Posts |  |
| Grace-Marie Turner Galen Institute View Posts |  |
| Nathan Benefield Commonwealth Foundation View Posts |  |
Posts on Innovation
[...] This post was mentioned on Twitter by Jon Evans and Solitary Conspiracy. Solitary Conspiracy said: RT @lward99 SURPRISE – Medicare denies more coverage than Evil Insurers http://tinyurl.com/ycsee29 #handsoff #optout #tcot #tlot [...]
If you add up all the providers claims and rejections and compare them to Medicare it comes out to a Denial rate of 4.05% on 2,447,216 claims vs Medicare’s 6.85% on 6.9 million claims.
Yeah, let’s improve the Health Care system by expanding Medicare… NOT.
[...] Which Insurer Denies the Most Claims? | statehousecall.org [...]
I wish you gave more context. This is raw data. It doesn’t mean much. Maybe doctors try to submit more gray-area claims to Medicare precisely because it accepts more claims? Maybe CIGNA is so low because of its reputation, so doctors don’t even try to submit claims that might be in a gray area. Without more digging, you can’t draw conclusions.
So, BO’s plan to reduce health care costs is to deny more claims. Ity Is BO’s plan to tell old people to go home and die, not republicans.
It is BO Appointees that wrote stuff like “Americans have to get use to the idea of not living so long.”
While this is certainly interesting information, and I’m no apologist for any of these companies or agencies, it must be said that to compare claim denials requires that one compare coverages and claims submitted for services not covered in the person’s individual plan. None of these insurers covers everything. Medicare covers old people, who, by their very nature, are more likely to submit claims for services clearly not covered by their plan. I’m not sure that we can judge Medicare by these statistics.
anon,
the link to the full report is here: http://www.hsabenefitsconsulting.com/blog
richard,
Actually, it’s not the elderly who file the claims with Medicare but the clerical staff at the providers’ offices who submit the claims. With the volume of claims that they file with Medicare annually, and the standardized plan designs offered by Medicare, one would think that the clerical team would be more familiar with Medicare’s benefits than they would be with the fewer claims submitted and variety of plans offered by private providers.
[...] October 6, 2009 · Leave a Comment Cross-posted from State House Call. [...]
For what it’s worth, 21% of Medicare’s claim denials had the following “reason code description”:
“These are non-covered services because this is not deemed a ‘medical necessity’ by the payer.”
It was the 2nd most common reason. See link in the post above.
Yes, Brian,
We are aware of that statistic. We can conclude that the physician thought it was medically necessary or she wouldn’t have filed the claim, but Medicare disagreed.
We have heard from doctors, patients, and clerical staff across the country since this blog was posted. Here’s what one physician wrote to us:
“The chance for error by government is huge. Our staff is very experienced at coding, with the same employees coding for over 15 years. Our coders know more than the Medicare reps they call. The system is Byzantine, and denials may be given for little or no reason. Some claims are paid with identical submission info, while others are denied.”
Here is a case in point where a 90-year-old man has been appealing a denial. The total process for him has been a nightmare. http://www.hsabenefitsconsulting.com/blog
The reality of the situation is that the government programs are bankrupt and massive rationing is on the horizon. The statists understand this and do not want a vital private sector to show the huge discrepancies in care between the private sector and the government that will develop. The plan is to suck the money out of the private sector so that everyone eventually keeps equivalent mediocre medical care. It would not have to be this way if the politicians would open the markets to individual control. They will not do this because politicians want two things: Money and Power. Neither can be accomplished by increasing individual freedom.
Well said, Dr. Mark.
[...] http://www.statehousecall.org/which-insurer-denies-the-most-claims [...]