Nurses union claim insurance deny cases often

September 4, 2009 7:40:37 PM PDT
A new report from the California Nurses Union comes to a disturbing conclusion -- that the biggest health insurance companies in the state are denying a high percentage of patient claims.

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In California the biggest medical insurance companies deny more than 20 percent of their claims. That's the gist of a report published by the state nurses union. A co-president of the union told ABC7 the union would like the insurance industry out of health care.

The numbers of medical claims denied comes from compiling monthly reports filed with the state. And those state reports show PacifiCare denies 39.6 percent of its claims, CIGNA 32.7 percent, Health Net 30 percent, Kaiser Permanente 28.3 percent, Blue Cross 27.9 percent, and Aetna 6.4 percent. A co-president of the California Nurses Association told ABC7 it still comes to more than 20 percent of medical claims being denied.

"Every denial is a cold hearted denial of life," says Zenei Cortez, RN, the California Nurses Association co-president. Cortez says the numbers show insurance companies are denying medical care. She says "Who are they to say who lives and who dies?"

However, a representative of the insurance industry says the numbers don't show that at all.

"The numbers are raw figures that give the information on what happens at the end of every month whether a claim is immediately paid or not," said Patrick Johnston with the California Association of Health Plans.

Johnston plans says 95 percent of claims are eventually paid.

"There is paperwork and it does take some time, but in all cases the care is given," says Johnston.

"They would say whatever they want, but still, you know, denied payment is denied care," says Cortez.

The nurses have their own interpretation and they've got California Attorney General Jerry Brown saying "These high denial rates suggest a system that is dysfunctional."

The attorney general says he'll investigate.

CIGNA told ABC7 on Friday, characterizing all payment denials as denials of coverage is inaccurate and irresponsible.

Kaiser Permanente told ABC7 "The claims analysis performed by the study was incorrectly applied to us."

All of the insurance companies that got back to ABC7 on Friday said pretty much the same thing. Their statements are more detailed and you see them in the link below.

The bottom line is the numbers reported by the nurses union were compiled at the state level and the state agency says they reflect payments made to doctors and hospitals. They do not reflect medical care denied.

LINK: Health insurance statements

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