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The increased attention also comes on the heels of a first-of-its-kind report issued this week that said the California health insurers reject 1 in 5 medical claims.
Six of the state's largest insurers rejected 45.7 million claims for medical care, or 22% of all claims, from 2002 to June 30, 2009, according to the California Nurses Assn.'s analysis of data submitted to regulators by the companies.
Six of the state's largest insurers rejected 45.7 million claims for medical care, or 22% of all claims, from 2002 to June 30, 2009, according to the California Nurses Assn.'s analysis of data submitted to regulators by the companies.
The rejection rates ranged from a high of 39.6% for PacifiCare to 6.5% for Aetna for the first half of 2009. Cigna denied 33%, and Health Net 30%.
Anthem Blue Cross, the state's largest for-profit health plan, and Kaiser, the state's largest nonprofit plan, each rejected 28% of claims.
Blue Shield, a nonprofit with 3.4 million California members, is the only large health plan that does not report claims-denial figures in its annual report to the state Department of Managed Health Care.
State health plans say claims often are denied because they are duplicates, because patients are no longer members, and because a particular treatment is not a covered benefit.
Anthem Blue Cross, the state's largest for-profit health plan, and Kaiser, the state's largest nonprofit plan, each rejected 28% of claims.
Blue Shield, a nonprofit with 3.4 million California members, is the only large health plan that does not report claims-denial figures in its annual report to the state Department of Managed Health Care.
State health plans say claims often are denied because they are duplicates, because patients are no longer members, and because a particular treatment is not a covered benefit.
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PacifiCare, the Cypress-based subsidiary of UnitedHealthcare Group, ranked highest in the state for claims denied in the first half of 2009. It has been the subject of considerable scrutiny for its claims-handling practices.
The HMO paid $3.5 million in fines last year for claims payment problems, and the department is conducting a follow-up examination.
"We still do get frequent complaints about PacifiCare, and obviously the numbers in the California Nurses Assn. report backed that up," Randolph said. "We do expect we will be taking some further action."
PacifiCare also faces a hearing this year over state Department of Insurance allegations of 133,000 violations of claims-handling laws that could result in as much as $1.33 billion in fines. ...
The HMO paid $3.5 million in fines last year for claims payment problems, and the department is conducting a follow-up examination.
"We still do get frequent complaints about PacifiCare, and obviously the numbers in the California Nurses Assn. report backed that up," Randolph said. "We do expect we will be taking some further action."
PacifiCare also faces a hearing this year over state Department of Insurance allegations of 133,000 violations of claims-handling laws that could result in as much as $1.33 billion in fines. ...
[No matter the rights / wrongs etc., one thing is clear ... the is the most expensive, inaccurate billing payment settlement process imaginable -- no wonder US healthcare has such exorbitant overhard costs. ed.]
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