Free Markets, Free People

Who Denies More Medical Claims Than All Others?

Well, unsurprisingly, it isn’t private insurance companies, in some cases by quite a large margin.  A chart from some recent research by Beverly Gossage of the Show-Me Institute makes the case:


You remember the outcry about CIGNA’s denial of Natalee Sarkisian’s liver transplant a couple of years ago? Well, as you can see by the numbers the chance of denial from Medicare is much higher than one from CIGNA.

It is these sorts of facts which are not apparent in the constant demonization of private insurance.

Interestingly, the AMA has come out in favor of government “health care reform” – whatever that may mean. The irony is the information that Ms. Gossage found came from the AMA’s own 2008 National Health Insurer Report. Is this the type of “competition and choice” the government insurance introduced in a public option would bring? Higher denial rates than private insurance?

I guess that’s insurance “reform”.



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10 Responses to Who Denies More Medical Claims Than All Others?

  • I’m looking forward to Erb’s spin on this. It’s bound to be epic.

    • Erb won’t touch this one. It is a statistic he can’t refute with his BS links so you won’t hear a peep from him.

  • Well, there’s some good news in there. I’m leaving my current job, which has Aetna, and taking a new job which uses UHC.

    Thank goodness I don’t have to worry about medicare!

  • I’m not sure this is a fair attack. I briefly read through the rest of the pages in the AMA report to see why claims were denied. It’s difficult to make an apples-to-apples comparison since Medicare doesn’t “terminate” coverage (a top reason for denial among the private companies), and there are few areas of overlap between the reasons among the private insurers and Medicare.

    If the argument against private insurance is that they unfairly terminate coverage when it is most needed, then the argument is still logically plausible.

    The data for “terminating” coverage doesn’t explain why the coverage ended. Did the insurer dump the patient, or did the patient switch companies and there was still confusion about to whom to submit the bills? The latter issue is an ongoing problem with my family doctor and my wife’s job which keeps switching insurers.

    It also strikes me as highly probable that doctors’ offices and hospitals submit as much as they can to Medicare in hopes of collecting whatever they can get, whereas they probably have a better idea of what is acceptable to submit to private carriers. I say this because the “not enough information” denial is at least 2-3 times higher under Medicare than the private insurers.

    • “Not enough information” denial can also be due to clerical errors, which I speculate (without any proof whatsoever) would be higher for Medicare. Example: When I went to get prenatal care for my 2nd pregnancy, the insurance company kept denying the claim. Finally a sharp-eyed pharmacist caught the problem: when I had enrolled they had entered my birthdate as 11/11/11, and the insurance company naturally wanted to know why an 89-year-old woman was seeking prenatal care.

  • Remember all those saving Obama promised by going to electronic health records …

    TORONTO – Ontario’s health minister bowed to months of opposition pressure and tendered his resignation Tuesday on the eve of a report into how the province spent $1 billion over 10 years to create electronic health records.