Insurance Q&A

December 21, 2009

Refusing Medical Claims

Filed under: Uncategorized — rrroark @ 1:41 pm

the Independent Institute took a look at the numbers published by the American Medical Association:

According to the American Medical Association’s National Health Insurer Report Card for 2008 , the government’s health plan, Medicare, denied medical claims at nearly double the average for private insurers: Medicare denied 6.85% of claims. The highest private insurance denier was Aetna @ 6.8%, followed by Anthem Blue Cross @ 3.44, with an average denial rate of medical claims by private insurers of 3.88%

In its 2009 National Health Insurer Report Card, the AMA reports that Medicare denied only 4% of claims—a big improvement, but outpaced better still by the private insurers. The prior year’s high private denier, Aetna, reduced denials to 1.81%—an astounding 75% improvement—with similar declines by all other private insurers, to average only 2.79%.

Maybe there’s something to be said for the need to keep your customers satisfied in order to make that profit after all. Of course, lower denial rates are not necessarily a good thing. It could mean that more fraud goes undetected.

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