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 |
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|
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 |