This is one of the dark corners of the black box that is private health insurance," said Karen Pollitz, a professor at the Georgetown University Health Policy Institute.
Data on how often insurance claims are denied -- and for what reasons -- is collected and analyzed by the insurance companies themselves. But except in California, the companies aren't required to provide those records to any state or federal agency. "The number is knowable, but not known by regulators or policy makers or patients," Pollitz said.
The main health-care reform bill being considered in the House does seek to address the matter. It would require health insurance companies to report data on claims policies, practices and denials to a central commissioner.
The issue of claims surfaced recently in California. The state Nurses Association issued a press release saying that data it obtained from the Web site of the state's Department of Managed Health Care showed that in just the first half of 2009, California's six largest HMOs had rejected more than 31 million claims -- 21 percent of those they had received.
The way the nurses group tells it, state officials didn't even know they had the data.
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