The Largest Denier of Health Care Claims....

  1. 2
    The AMA did a study and published it in 2008 and found that Medicare denied 6.85% of claims, a figure that is larger than any of the largest private insurance companies. It is also more than twice the average of all the private insurance companies.

    Just something to consider when rallying behind a "public option" in any health care reform legislation. The current government-run government-provided health insurance denies more claims than any of the largest private insurance companies. I for one don't expect that to change with enlarging government's role in providing our health care.

    "Of the eight insurers listed, Medicare is most likely to reject a claim, sending away 6.85% of requests. This is more than any private insurer and double that of the private insurers’ average!
    In short, the AMA is endorsing a plan whose closest existing example is the most frequent denier of claims. How the public option exemplifies “delivering care to patients” is unclear."--Big Government, 10/5/09
    FLmomof5 and Pierrette like this.
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  3. 5 Comments so far...

  4. 7
    did you read the study? aetna also rejected 6.0 % of claim lines denied.

    how about "percentage of claim lines reduced to $0 by edits" nr = not reported

    health insurer
    aetna 3.40%
    anthem bcbs 7.33%
    cigna 3.75%
    coventry 0.31%
    health net nr
    humana 3.17%
    united healthcare (uhc) 9.15%
    medicare 1.40%


    or
    on what percentage of records does the payer’s allowed amount equal the contracted payment rate?

    health insurer
    aetna 70.78%
    anthem bcbs 72.14%
    cigna 66.23%
    coventry 86.74 %
    health net nr
    humana 84.2 %
    united healthcare (uhc) 61.55 %
    medicare 98.12%


    different picture now.
    Last edit by NRSKarenRN on Oct 9, '09
    FraidoCat, RN4MERCY, HM2VikingRN, and 4 others like this.
  5. 5
    And what about the recent study released by the CNA?

    "CNA/NNOC researchers analyzed data reported by the insurers to the California Department of Managed Care. From 2002 through June 30, 2009, six of the largest insurers operating in California rejected 47.7 million claims for care -- 22 percent of all claims."

    http://www.calnurses.org/media-cente...of-claims.html
    FraidoCat, RN4MERCY, HM2VikingRN, and 2 others like this.
  6. 1
    Quote from elkpark
    And what about the recent study released by the CNA?

    "CNA/NNOC researchers analyzed data reported by the insurers to the California Department of Managed Care. From 2002 through June 30, 2009, six of the largest insurers operating in California rejected 47.7 million claims for care -- 22 percent of all claims."

    http://www.calnurses.org/media-cente...of-claims.html
    Were these initial denial or final denials. And isn't CALNURSES a tad biased?
    lindarn likes this.
  7. 6
    Quote from Onekidneynurse
    Were these initial denial or final denials. And isn't CALNURSES a tad biased?
    We nurses are biased in favor of patients.
    But the facts are data reported by the insurers to the California Department of Managed Care.

    Insurance companies have not disputed the report.

    http://www.reuters.com/article/press...09+PRN20090902
    FraidoCat, GCTMT, RN4MERCY, and 3 others like this.
  8. 1


    Received a rejection claim under my name from BC Personal Choice and bill from local hospital for ~$3,300 for my 23yo son's 9/09 CAT scan due to kidney stones which had preauth...........

    ..............from AETNA, his insurance of record since last December since working FT. Handed it to him today to get straigtened out. He said handed insurance cards to reception dsek and at checkout when test was set up; sure it's just a matter of billing staff not end dating prior policy.

    Just add me to the list of claim rejections for no active policy.

    herring_RN likes this.


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