In my previous post I said that someone should publicize claim denial rates for Obamacare more widely. Why not me? It's a great big chart with 162 insurers, but I guess I've got the room.
35 thoughts on “All the Obamacare insurers listed in order of claim denial rates”
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Why are only a few states represented?
Perhaps because this is insurers on healthcare.gov, which presumably excludes those on state-run exchanges like Pennie in PA or Kynect in KY.
Exactly. I figured that out when I noticed no California insurer is listed. Californians use “Covered California,” not “Healthcare.gov.”
That also explains why the list has mostly red states: most blue states set up their own exchanges while most red states did not so they use the national exchange.
It's only states that are on the federal exchange.
AL is on the federal exchange.
Oscar looks good!
People with routine health conditions don’t get denied for prescriptions or annual blood work. People who are injured don’t get denied treatments either. Are they submitting claims for things not covered under their plan like… what would that even be? Is partial coverage of a ER visit classified as a denial? Very odd.
I got denied zofran which I needed to deal with nausea caused by another med I was taking for an infection. Family member got denied eletriptan for chronic migraine, but was allowed sumatriptan. Injury treatment can be denied if the insurer thinks it was work related--it goes under Workers Comp, or auto accident should go under at-fault driver's insurance.
Zolfran seems to be not covered quite a bit. So says google anyway. Oh well. Thanks for your reply. I guess I’m just not up to speed. I had a broken bone in 2023 and it all went fine. Employer insurance. Can’t wait to retire.
I’ve been fighting for three months over a follow up X-ray my child had after they fell and broke a bone. Apparently confirming it had healed properly is excessive?
Is no one going to say anything about how there are more bars than labels? Kevin, your chart is a little broken.
Mismatch of legend with contents has happened before, though I don't check every graph.
I have no conclusion to draw from this, but the company that set off this manic discussion in the first place, United, is among the worst.
Claim denial does not equate to denial of care. There are many reasons why claims are denied and most of them are due to providers incorrectly submitting claims. A better analysis would be percentage of "clean claims" paid by insurers within 30 days
Actually, when my wife was working as a receptionist for a local MA doctor back in the late 70s and early 80s, he used a claim service specializing in making sure the claims were well vetted. He still had to spend close to 20% of his and his nurse assistant's time fighting the health insurers because they would delay payment till a new claim schedule came out and then deny the claim because the code had changed after filing.
Fortunately I worked for DEC back then, and they self insured (as did EMC when I worked from them later - up till 2018). The insurers were hired only for processing and understood that they were on a short leash. Sounds like quality control in the red states could stand some sharp scrutiny.
Yet another reason to mourn the demise of Digital Equipment.
Claims and claim submission has only gotten more complicated over the past 20 years. Just look at the UB04 and 1500. There are numerous fields that if you put the wrong date, procedure code of location it will be denied. Again, I'm not saying insurers don't deny claims incorrectly but my experience has shown that much of the fault lies with providers and their errors. A true analysis of denied claims would be "Clean Claims" or claims without errors paid within 30 or 45 days
When claims are denied, patients may face significant financial burdens or delays in receiving care. Sure, not denial, but that is semantics is facing this situation
And if the claims process is this complicated and challenging to do "cleanly", that seems like a feature of the system.
I loved this clip from CNN with Kevin O'Leary. Read. The. Room. Instead of hiring security, they need to be fixing the problem.
https://youtu.be/zl6saOjAAUY?si=a1YTrApGyfsZHn0U
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Kennedy’s Lawyer Has Asked the F.D.A. to Revoke Approval of the Polio Vaccine
Aaron Siri, who specializes in vaccine lawsuits, has been at Robert F. Kennedy Jr.’s side reviewing candidates for top jobs at the Department of Health and Human Services
The lawyer helping Robert F. Kennedy Jr. pick federal health officials for the incoming Trump administration has petitioned the government to revoke its approval of the polio vaccine, which for decades has protected millions of people from a virus that can cause paralysis or death.
That campaign is just one front in the war that the lawyer, Aaron Siri, is waging against vaccines of all kinds.
It seems to me that the chart, while interesting, is missing key data.
- how many of the denials were valid, based on the policy or standards of medical care?
- how many of these denials were resubmitted and ultimately approved? Meaning this was an administrative challenge versus a true denial of medical care.
- how much of the variance is associated with variation in the unique insurance pool of an insurance company? Some areas of the US have higher insurance fraud. Insurance companies have variation based on age, military etc.
The real question to me, how many valid insurance claims were denied and the person never got the care they were intitled to: it is dangerous/possibly misleading to make informed inferences, based just on that chart.
define "valid insurance claim"
SeanT
As a non medical professional (married to a medical doctor..lol), A valid insurance claim would have to include 1) covered by the policy 2) the potential medical treatment, meets the local medical standard of care.
Do you accept that not 100% of medical claims, similar to virtually all types of insurance, are valid?
According to Google
FBI: Estimates that fraud accounts for 3–10% of health expenditures
General Accounting Office: Estimates that health care fraud, waste, and abuse may account for as much as 10% of all health care expenditures
Note, these costs are for APPROVED claims
I got a hearing aid a few years ago from a business that was grafted onto an ENT practice. The bones in my ears have been partially fused since birth so the frequency response has always been poor. Anyhoo, the hearing aid specialist said I "had" to talk to the ENT in case I had a tumor, so I walked through the ENT door. The ENT sits in an exam room drinking coffee when the hearing aid guy is seeing clients, ready to spring into action. He said "maybe you have a tumor" and I said "I don't have a damn tumor" and he said "OK, fine." That showed up as a $400 bill to my insurance. Was that valid?
gs - it was not my goal to defend insurance companies.
Rather, its my observation, and some percent of claims should be denied: the price of insurance, absent denial of invalid claims would be much higher.
Thus, its not the denial rate, as an absolute number, but rather the denial of valid claims that should be of concern.
I'm surprised that Mr. Drum came down from on high to offer a clarification (while not actually including the information that people were missing).
I am so impressed by the Pacific Northwest insurers' low rate of denial of coverage. Yet, I'm almost certain that the rate is much higher for ESIs.
But wow, WTF is up with that cluster of insurers with denial rates approaching 50%? That is messed up.
When an executive is murdered I consider it inappropriate (actually much worse than that) to bring up the topic of customer dissatisfaction with whatever service/product provided by the company the executive worked for. Do that some other time, when claim-denial is in the news (even if it's only statistics and not a personal narrative).
Right now we are witnessing a lot of "he had it coming" or "there's only so much people can take " (E Warren). That's disgusting.
Ugh.
When 26 children (and some teachers) were murdered at Sandy Hook Elementary School, they said it "wasn't appropriate" to bring up gun control when emotions were running hot.
Ugh.
I'm usually a mild-mannered guy and try to live up to that especially online. But fuck you Dana Decker. Just fuck off. I will skip any future comments from you here. Thanks for having a distinctive avatar so I can do that easily.
Difference:
Sandy Hook - people were not saying that the killer's motivation made sense. Gun policy was not related to killer's state of mind, and was therefore acceptable to discuss.
United Healhcare - (some) people are saying that the killer's motivation was, while not justified, was *understandable* because they and others hate how health insurers function. Those two topics, murder and health care policies are best discussed separate from each other in time, not combined as they are in this instance.
It's only natural for the people to speculate on how to prevent similar deaths or to understand the underpinnings of the public's ire.
KD's looking at data to examine the narrative.
My angle is slightly different. I think Trump's the true cause of this violence, by pushing gun rights, moral absolutism, and populism. With his dehumanizing, he allows people to remove empathy from their actions. A decade of this and the violence that follows is predictable, including the two attempted assassinations of the fool himself.
Can you please, for god's sake, embiggen the damn thing? My eyes are 65 years old and weren't that great to begin with.
Right-click to open in a new tab.
Obamacare plans have to operate above a certain minimum Medical Loss Ratio, which is 80% or more by law. They have to pay out in claims at least 80% of what they take in as premiums. So what the heck is going on with those insurers that deny so many claims? I don't know. Maybe they write stingy policies and compete by keeping their premiums low.