Help Us Investigate How Often Health Insurers Deny Claims

Amid all the loud arguments about the proper role for government and private companies in American health care, one point often seems lost: Exactly how well -- or badly -- are private insurers handling claims in the existing system?

It's a tough question to answer because, apparently, no one outside of the health insurance industry has analyzed how often health insurance claims are denied, and for what reasons.

"The routine denial of care by private insurers is like the elephant in the room no one in the present national healthcare debate seems to want to talk about," says Deborah Burger, co-president of the California Nurses Association and the National Nurses Organizing Committee.

The Huffington Post Investigative Fund has decided to look into this. And we'd like your help.

As you can see from this article by the I-Fund's Danielle Ivory, we were inspired by a recent report from the California Nurses Association, which pulled down some interesting data from the Web site of the state's Department of Managed Care. According to the association, six of the largest insurers operating in California rejected 47.7 million claims for care over a seven-year period -- 22 percent of all the claims they received.

There's a lot we don't know about these numbers. Were these claims initially turned down and later approved? How many of these rejections meant that people didn't get the health care they needed or wanted? How precisely do the insurance companies decide which claims to approve and deny?

Based on Ivory's preliminary findings, only California requires insurance companies to publish claims denials.

So we are looking for help from you. We'd like to recruit people with expertise -- in the insurance industry, hospitals and doctors' offices, state agencies, among other areas -- as well as concerned citizens interested in becoming watchdogs on this issue. You will join the citizen-journalists who already have volunteered for our Health Care Investigative Unit.

What we find out together could be important in the ongoing health care debate. In fact, it might be one of the most overlooked aspects of the health system. Sign up for our team below. We look forward to hearing from you.

Follow the Huffington Post Investigative Fund on Twitter and Facebook.

Comments

[Leslie Morgan]

I'm in. Working as a medical insurance biller for the last several years, I've got some stories to tell about the health insurance industry. I would love an opportunity to call them out on their shenanigans.

[1differentdrummer]

This has been going on for a long time, especially in prescriptions.

[matandch]

To report insurance fraud: Call 1-800-TEL-NICB. Give the name of the INSURANCE COMPANY that ripped YOU off!

[Joyana]

Long overdue -- a monitoring unit of the health insurance industry. We need to monitor: 1) Deductible paid by consumer (a. consumers' out-of-pocket expense); 2) Time period between filing claim and payment; 3) Percentage of insurance payment made (b. consumers' out-of-pocket expense); 4) Index of satisfaction of consumer; 5) Percentage of monthly earnings in health insurance premium deductions from pay check(c. consumers' out-of-pocket expense);6) Wellness benefits, such as no out-of-pocket costs for annual doctor's wellness exams.

[canarypapers]

A Health Care Investigation Unit? That's an awfully tiny net for such a huge swath of the population. A better idea -- a more accurate way of counting the numbers -- would be to post an online forum where the millions who have been denied coverage could be allowed to post their stories. Otherwise, you risk missing a lot of people, most of whom ( having fallen through all the safety nets, and no longer being on the radar of the insurance industry, hospitals and doctors' offices, state agencies etc.) would be invisible to such an investigation.

Put up a forum, ala Field of (nightmarish) Dreams. You build it, they will come. And I'll be there with bells on to tell my own story.

[JimShanor]

Why not bring a class action suit and subpoena the bloody data from the insurers. Call on whistleblowers and freeze the shredders.

[Danielle Ivory]

canarypapers -- people are writing in with their stories. Please feel free to sign up above if you haven't already.

[hootie1fan]

My mother has been a diabetic for 40 years and on insulin for almost all of that time. When Mom was preparing for her mastecomy, her big name private coproate insurance told her that she didn't ned insulin so they weren't going to cover it. No one talked to her much less her doctor before the corpoate insurance bureaucrats made this decision. What do they think is going to happen to a retired diabetic on a fixed income? Luckily for her, she had Medicare. 6 moths later and her private insurance is still denying her coverage for her insulin.

Why work for decades, paying into a pension plan that includes private insurance to haev them deny you?

[jezzabella]

I don't quite understand your post. In addition to your mother's Medicare A (hospital) and B (doctor's visits), she has a drug card (not part D Medicare drug plan) and she has a Medicare supplement provided by her former employer?
It sounds like she has the drug card she is entitled to in her retirement plan and they are trying to force her to take Medicare Part D drug plan. They can't do that unless they boot all retirees from the plan - which has been happening. Once she goes on Medicare Part D, she can't have any other drug plan or card. Many retirees do not go on Part D and keep their original drug plan that is part of their retirement package because it pays more.
I hope I haven't added more confusion to this post.

[hootie1fan]

Her private insurance is supposed to cover her first, but they've made a point of denying coverage so she's had to to switch over to her Medicatre coverage. What's the point of paying into a private plan when in retirement they are going to force you to go elsewhere?

[XCITIZEN]

WE NEED TO BEGIN THE POPULIST MOVEMENT TO SHUT DOWN THE HEALTH INSURANCE INDUSTRY - NOW!

[Joyana]

Let's shut down the health insurance and credit card industries!!! Both industries are rip offs of the American People!!

[Yurasis Dragon]

If you use your credit card responsibly and pay in full every month, they're only making