A new report from the California Nurses Association, “California’s Real Death Panels: Insurers Deny 21% of Claims,” shows a shocking — but not surprising — rate of denial of claims among California health insurers:
More than one of every five requests for medical claims for insured patients, even when recommended by a patient’s physician, are rejected by California’s largest private insurers, amounting to very real death panels in practice daily in the nation’s biggest state, according to data released Wednesday by the California Nurses Association/National Nurses Organizing Committee.
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.
Claims denial rates by leading California insurers, first six months of 2009:
- PacifiCare — 39.6 percent
- Cigna — 32.7 percent
- HealthNet — 30 percent
- Kaiser Permanente — 28.3 percent
- Blue Cross — 27.9 percent
- Aetna — 6.4 percent
“Every claim that is denied represents a real patient enduring pain and suffering. Every denial has real, sometimes fatal consequences,” said Burger.
PacifiCare, for example, denied a special procedure for treatment of bone cancer for Nick Colombo, a 17-year-old teen from Placentia, Calif. Again, after protests organized by Nick’s family and friends, CNA/NNOC, and netroots activists, PacifiCare reversed its decision. But like Nataline Sarkisyan, the delay resulted in critical time lost, and Nick ultimately died. “This was his last effort and the procedure had worked before with people in Nick’s situation,” said his older brother Ricky.
No one should be surprised by these numbers. The practice of denial — the key to insurance company profits — is exactly what Wendell Potter, former executive with Cigna, has been shouting from the rooftops so relentlessly for the last several months.
If health care reform legislation does not include some method — such as the so-called public option — for curbing obscene insurance company profits, then it will not be true reform.
Better yet would be a single-payer system, such as Medicare, which could destroy the monopoly power of insurance companies.