Transparency in Insurer Claim Approval and Denial Rates – Claim Denials Seem to Lead to Greater Profit

Like the average consumer, we are always curious about the claim approval and denial rates of health insurance companies. A new law in Vermont satisfies that curiosity by requiring health insurers who do business in Vermont to disclose claim denial rates. Not surprisingly, the insurer with the largest profit also had the highest denial rate. Blue Cross Blue Shield of Vermont denied 7.6% of claims, MVP denied 15.5% of claims, and Cigna denied 21% of claims. Blue Cross and MVP are non-profit companies and Cigna is a for-profit corporation.

The most alarming statistic is that of the 377,352 claims that were denied last year (as reported to Vermont) there were only 456 post-service appeals. That means that 99.8% of all denied claims are never appealed. What this really means is that health insurers are winning the fight unless insureds are willing to step up and hold insurance companies accountable for benefits that are available and payable under the policy. As the Vermont Public Interest Research Group (VPIRG) reported, “These numbers confirm what we already knew, that insurers have little disincentive to deny claims when there is such a miniscule chance that these denials will actually be appealed.”

You can read more about Vermont’s efforts to gain transparency at Vermont Public Interest Research Group’s website: http://www.vpirg.org/news/pulling-back-the-curtain-on-denied-claims/ and a link to the filings of MVP and Blue Cross at http://vtdigger.org/2013/03/20/new-disclosures-show-mvp-denied-15-5-percent-of-patient-claims-in-2012-blue-cross-denied-7-6-percent/
And http://www.huffingtonpost.com/wendell-potter/the-higher-health-insurer_b_3137831.html

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