California State HMOs deny 1 in 5 claims


	California State HMOs deny 1 in 5 claims

glennbah

9-6-2009 11:40 AM

355 views

glennbah says:

It's time to stop talking about make believe death panels, and talk about the real ones. I had been going on the assumption the health insurance industry made (kept) $13,000,000,000 last year in profits. I was off by a couple billion dollars...it is closer to $16,000,000,000...opps!

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9-6-2009 12:39 PM

lifecyce1898

thank you. I work in Utilization management at one the countries leading mental health facilities and the denial rate seems higher than that.

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<div style="margin: 12px 0px; font-family: arial; color: #333333; background: #ffffff; border: solid 4px #e5e5e5; width: 100%; clear: left;"><div class="CM_CTB_Content_Wrap" style="margin: 0px; padding: 0px;background-color: #ffffff;"><div style="border-bottom: solid 1px #dcdcdc; white-space: nowrap; margin-bottom: 8px; background-color: #eeeeee ;background-image: url(http://clipmarks.com/images/source-bg.gif); background-repeat: repeat-x; height: 24px; line-height: 24px; vertical-align: middle; padding-bottom: 4px; color: #666666; font-size: 10px;" ><a href="http://clipmarks.com/clip-to-blog/" title="see clips that are hot right now"><img src="http://content.clipmarks.com/blog_embed/64504128-828c-47d9-b81d-7649242b821e/47F8B183-C3C0-4AE9-BD56-6D22B541B311/" alt="" width="19" height="19" border="0" style="vertical-align: middle; margin: 0px 4px; display: inline; border: none; float:none;" /></a>clipped from <a title="http://www.latimes.com/news/nationworld/nation/healthcare/la-fi-insure-denials3-2009sep03,0,1423324.story" href="http://www.latimes.com/news/nationworld/nation/healthcare/la-fi-insure-denials3-2009sep03,0,1423324.story" style="font-size: 11px;">www.latimes.com</a></div><blockquote style="text-align: left; padding: 0px 8px; margin: 4px 0px 8px 0px; background: transparent; border: none;" cite="http://www.latimes.com/news/nationworld/nation/healthcare/la-fi-insure-denials3-2009sep03,0,1423324.story"><H1>State HMOs deny 1 in 5 claims, analysis shows</H1></blockquote><div style="height: 2px; font-size: 2px; background: #dcdcdc; border-bottom: solid 1px #f5f5f5; margin: 2px 4px;"></div><blockquote style="text-align: left; padding: 0px 8px; margin: 4px 0px 8px 0px; background: transparent; border: none;" cite="http://www.latimes.com/news/nationworld/nation/healthcare/la-fi-insure-denials3-2009sep03,0,1423324.story"><H2>A nurses group says state government data show that denial rates among the five largest insurers ranged up to 39.6% in the first half of 2009. The firms caution that the figures are misleading.</H2></blockquote><div style="height: 2px; font-size: 2px; background: #dcdcdc; border-bottom: solid 1px #f5f5f5; margin: 2px 4px;"></div><blockquote style="text-align: left; padding: 0px 8px; margin: 4px 0px 8px 0px; background: transparent; border: none;" cite="http://www.latimes.com/news/nationworld/nation/healthcare/la-fi-insure-denials3-2009sep03,0,1423324.story"><DIV>
California HMOs reject one out of five medical claims, according to an analysis by the California Nurses Assn. of data the companies submit to the state.</DIV></blockquote><div style="height: 2px; font-size: 2px; background: #dcdcdc; border-bottom: solid 1px #f5f5f5; margin: 2px 4px;"></div><blockquote style="text-align: left; padding: 0px 8px; margin: 4px 0px 8px 0px; background: transparent; border: none;" cite="http://www.latimes.com/news/nationworld/nation/healthcare/la-fi-insure-denials3-2009sep03,0,1423324.story"><DIV>The denial rates ranged from a low for Aetna of 6.5% to a high for PacifiCare of 39.6%, for the first half of 2009. Anthem Blue Cross, the state's largest for-profit health plan, and Kaiser, the state's largest nonprofit plan, each rejected 28% of claims during the first six months of this year, according to the study. And Cigna denied 33%. </DIV></blockquote><div style="height: 2px; font-size: 2px; background: #dcdcdc; border-bottom: solid 1px #f5f5f5; margin: 2px 4px;"></div><blockquote style="text-align: left; padding: 0px 8px; margin: 4px 0px 8px 0px; background: transparent; border: none;" cite="http://www.latimes.com/news/nationworld/nation/healthcare/la-fi-insure-denials3-2009sep03,0,1423324.story">"Every claim that is denied represents a real patient enduring pain and suffering,"</blockquote><div style="height: 2px; font-size: 2px; background: #dcdcdc; border-bottom: solid 1px #f5f5f5; margin: 2px 4px;"></div><blockquote style="text-align: left; padding: 0px 8px; margin: 4px 0px 8px 0px; background: transparent; border: none;" cite="http://www.latimes.com/news/nationworld/nation/healthcare/la-fi-insure-denials3-2009sep03,0,1423324.story">The analysis</blockquote><div style="height: 2px; font-size: 2px; background: #dcdcdc; border-bottom: solid 1px #f5f5f5; margin: 2px 4px;"></div><blockquote style="text-align: left; padding: 0px 8px; margin: 4px 0px 8px 0px; background: transparent; border: none;" cite="http://www.latimes.com/news/nationworld/nation/healthcare/la-fi-insure-denials3-2009sep03,0,1423324.story">on state government-collected data -- concluded that from 2002 through June 30, 2009,</blockquote><div style="height: 2px; font-size: 2px; background: #dcdcdc; border-bottom: solid 1px #f5f5f5; margin: 2px 4px;"></div><blockquote style="text-align: left; padding: 0px 8px; margin: 4px 0px 8px 0px; background: transparent; border: none;" cite="http://www.latimes.com/news/nationworld/nation/healthcare/la-fi-insure-denials3-2009sep03,0,1423324.story"> largest insurers in the state rejected 31.2 million</blockquote><div style="height: 2px; font-size: 2px; background: #dcdcdc; border-bottom: solid 1px #f5f5f5; margin: 2px 4px;"></div><blockquote style="text-align: left; padding: 0px 8px; margin: 4px 0px 8px 0px; background: transparent; border: none;" cite="http://www.latimes.com/news/nationworld/nation/healthcare/la-fi-insure-denials3-2009sep03,0,1423324.story">state rejected 31.2 million</blockquote></div><div style="margin: 0px 6px 6px 4px;"><table style="font-size: 11px;border-spacing: 0px;padding: 0px;" cellpadding="0" cellspacing="0" width="100%"><tr><td style="background:transparent;border-width:0px;padding:0px;">&nbsp;</td><td align="right" style="background:transparent;border-width:0px;padding:0px;width:107px" width="107"><a href="http://clipmarks.com/share/47F8B183-C3C0-4AE9-BD56-6D22B541B311/blog/" title="blog or email this clip"><img src="http://content7.clipmarks.com/images/c2b-foot.png" border="0" alt="blog it" width="107" height="17" style="border-width:0px;padding:0px;margin:0px;" /></a></td></tr></table></div></div>

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