Which Health Insurance Carrier Denies the most Claims?

According to page 5 of the  2008 Health Insurance Report Card released by the American Medical Association, the “carrier” with the highest percentage of denials is…..Medicare. Does it still sound like we need to put the government in control of (or develop a public option to compete with) health insurance companies to prevent them from denying claims?

DENIALS

Metric 12—Percentages of claim lines (i.e., records) denied Description: What percentage of records submitted are denied by the payer for reasons other than a claim edit? A denial

is defined as: allowed amount equal to the billed charge and the payment equals $0.

Source: NHXS

Payer

Count of records

Denied records

Percent of

claim lines

denied

Date range

Aetna

637,239

43,317

6.80%

03/01/2007 – 3/10/2008
Anthem

250,070

11,546

4.62%

03/01/2007 – 3/10/2008
CIGNA

263,728

9,060

3.44%

03/01/2007 – 3/10/2008
Coventry

20,487

590

2.88%

03/01/2007 – 3/10/2008
Health Net

4,975

193

3.88%

03/01/2007 – 3/10/2008
Humana

143,026

4,142

2.90%

03/01/2007 – 3/10/2008
Medicare

6,938,431

475,566

6.85%

03/01/2007 – 3/10/2008
UHC

1,127,691

30,177

2.68%

03/01/2007 – 3/10/2008

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