They Don't Call It "Sick For Profit" For Nothing

The California Nurses Association has put together a fantastic report detailing the denial rates on claims by leading insurance companies.

Researchers from the California Nurses Association/National Nurses Organizing Committee analyzed data reported by the insurers to the California Department of Managed Care. From 2002 through June 30, 2009, the six insurers rejected 45.7 million claims -- 22 percent of all claims.
For the first half of 2009, as the national debate over healthcare reform was escalating, the rejection rates are even more striking.

Claims denial rates by leading California insurers, first six months of 2009:
• PacifiCare -- 39.6 percent
• Cigna -- 32.7 percent
• HealthNet -- 30 percent
• Kaiser Permanente -- 28.3 percent
• Blue Cross -- 27.9 percent
• Aetna -- 6.4 percent

This has been the way that the 18 top insurers in America have received $16 billion dollars in profits last year. They deny care and make bank off it. As the Nurses report states, "If the private insurers are not paying for care, why do we have private insurers?"

After coverage of this report in the LA Times and the Sacramento Bee, Jerry Brown, the Attorney General of California, has opened an investigation into these allegations.

The inquiry was prompted by a report released Wednesday by the California Nurses Association. The report suggested that the insurers rejected a fifth of all claims received over the past seven years.

"The public is entitled to know whether wrongful business practices are involved," Attorney General Jerry Brown said Thursday in a statement.

The spokesman for the insurance industry in California blamed this on "paperwork issues." Lost in that paperwork are people like Nataline Sarkisyan and Nick Colombo, who died from denial of care.

As bad as these denials are, there's also the crisis that 2.2 million Californians have medical debts, with a third of those bills over $2,000.

"That even insured people are forced to take on medical debt to pay for their health care is another glaring inadequacy in our current system of health insurance," said E. Richard Brown, director of the UCLA center. "Current policies either do not offer enough coverage or offer full-coverage at a cost that is too expensive for many people to bear. The result is that too many people have health insurance plans that leave them financially vulnerable and force them to delay the care they need."

It's amazing that these kind of discussions aren't the number one subject when it comes to medical care, instead of people shouting in town hall meetings.