RNs Praise Attorney General Move to Subpoena Insurance Plans

OAKLAND, Calif., Feb. 25 /PRNewswire/ -- The California Nurses Association/National Nurses Organizing Committee today praised the announcement from California Attorney General Jerry Brown that he will subpoena records from seven of the state's biggest private insurance companies to review their policies that have led to public outrage over denials of claims and huge rate increases.

Brown began an investigation following release of research by CNA/NNOC last September, and extensive media reporting, that documented that since 2002 more than one of every five requests for medical claims for insured patients have been rejected by California's largest private insurers.  

Today CNA/NNOC released new data from its research arm, the Institute for Health and Socio-Economic Policy – also based on publicly available data from the California Department of Managed Care. It shows that despite the public uproar following the initial reports last September, the high denial rates were actually higher for the last six months of 2009, averaging 26 percent for seven large insurers.

Claims denial rates by leading California insurers, second half of 2009, compared to the first six months of 2009:

• PacifiCare – 41.17 percent (up from 39.6 percent for the first six months of 2009)
• Cigna – 35.43 percent (up from 32.7 percent)
• HealthNet – 25.82 percent (down from 30 percent)
• Kaiser Permanente – 26.96 percent (down from 28.3 percent)
• Anthem Blue Cross – 24.5 percent (down from 27.9 percent)
• Aetna – 6.4 percent (no change)
• Blue Shield – 22 percent (Blue Shield had previously not reported separate denial data, and only began reporting after the media reports on denials)

For the reporting period of July 1, 2009 to December 31, 2009, the denials average 26.05 percent by the seven insurers.

"What we see over and over is an arrogant industry that is indifferent to the pain and suffering caused by routine care denials or economic catastrophe prompted by outrageous price gouging," said CNA/NNOC Co-President Geri Jenkins.

"The denials and pricing practices are both motivated by the prime directive that seems to surpass everything else for these companies –  squeezing their patients and providers alike for profits and revenues regardless of who gets hurt along the way."

"We applaud the effort of the Attorney General to more carefully scrutinize the behavior and records of the insurers. They must be held accountable to the public for their disgraceful and potentially illegal behavior," Jenkins said.  

SOURCE California Nurses Association/National Nurses Organizing Committee