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67 Million Claims Denied in California Since 2002

February 1, 2011

If there is one area that could help Americans in their healthcare, it would be insurance reform. Health insurance is a business, first and foremost and it is like any other business: it’s main focus is profits. Health insurance is so expensive now that 48 million Americans cannot afford it and do without. For those who have it, claim denial is unethical in many ways. Insurance companies make big promises to ‘members’ or ‘holders’, and then actively seek to deny claims. Thus, it is exploitive. It also artificially props of high costs for doctors and hospitals and generally engages in false advertising. Do No Harm is the Hippocratic oath taken by physicians. What could do more harm than to deny care for people in need?

NPR reports today:
California — A new report reveals California’s largest health insurers denied on average of one out of four claims last year. The California Nurses Association issued the report.

The CNA says its findings are based on information health insurers provide to state regulators.

For the first three quarters of last year, insurance companies denied more than 13 million claims. PacifiCare led the way by initially rejecting nearly 44 percent of all claims. Anthem Blue Cross denied 27 percent of claims.

The CNA’s Chuck Idelson said this industry-wide problem has been going on for a long time.

“We’ve tracked it back to 2002,” Idelson said, “and there have been 67 million claims denied in California in the last eight years.”

Insurers deny claims for a variety of technical reasons, saying the service provided was not a covered benefit, or the patient was no longer a member of the plan. Insurance companies say they pay most “eligible” claims.

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