Those numbers are for over a year period and can not possibly reflect an accurate total denial rate as there is NO way the total claims can be correct. This study lists (for Example) Cigna having 263,000 claims in a little over a year period. Umm...Cigna had 11.4 MILLION members at the end of 2008. Cigna would have 263000 claims in a month or so period so how the heck does this study say they have that few claims in a year?
Here is some rebuttal to that info...take it for what it is worth:
Take a look at a MUCH larger sample in California, over a 6 month period. A 10 day sample is just NOT large enough to get an accurate sample.
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
Additionally a KEY difference is Medicare takes EVERYONE even if they are sick or have pre-existing. Private insurance can deny anyone coverage for any reason, so their base population is not as sick. Also, I work with a Hospital application that processes Medicare and almost ALL Medicare denials are reviewed and then accepted. If private health insurance denies you, you are done.