PacifiCare's Kill Rate 40%, CIGNA's 33% According to Government Data

New data from California unearthed by the California Nurses Association reveals denial rates by the top health insurers in America. Talk about "death panels"? PacifiCare's rate of denying claims is 40%, CIGNA's is 33%.

Overall one in five requests for treatment is denied by California health insurers regulated by the California Department of Managed Health Care. That's a 20% denial rate.

President Obama said he will be addressing Congress next week about his vision for health care reform. How about a vision that holds health insurers legally accountable for delaying and denying necessary medical care?

How do we know the requests were legit? Just watch CIGNA whistle-blower Wendell Potter explain why a teenage transplant patient, Natalie Sarkysian, died before getting her request approved.

It's time for President Obama to put legal accountability for the health insurance death squads back into the debate, and Congress is the place to do it.

As my colleague Harvey Rosenfield, author of landmark insurance reform Prop 103, says, these odds make Vegas look good. Only in Vegas you are not betting with your life.

 

 

Comments

[Samalabear]

As Rep. Anthony Weiner has asked, why are we keeping these death-panel companies in power?

For certain members of Congress, including Obama, it for their war chests, plain and simple. When things are this bad you need to start from scratch. But wait, we're not starting from scratch. We already have a single-payer system in place.

Under the present legislation people would be forced to buy from these companies in the form of mandates and our taxpayer dollars will go to subsidize a percentage of those policies. Public dollars to a private corporation. I thought people were fed up with bailouts or the government propping up private industry.

How do most Americans feel being forced to buy private insurance from these "death panel" companies? Do you think if a real leader got out there and told the people in stark terms what the stats are, as in this article, they would really want to keep these companies front and center in health care?

[alibeamish]

If you try to do what you are told is the right thing in buying insurance then a couple pays 8,000 per year.
But if your care isnt covered then your money is wasted. In 10 years 80,000.
So is it better to save the money and buy a trailer or shack in the woods and rely on emergency rooms?

[Realization]

The GOP says it wants a free market solution. Free markets and choice require that consumers have really good information. Stats on denials, etc. have to be publicized and readily available. Consumers also need info on how much executives make and the whole 9 yards. That would put to rest talk of rationing by government.

Having said that, the real issue is simple.

The U.S. spends over 16% of GDP on health care while other developed nations spend about 10% for universal coverage with less bureaucracy and unfairness. Cutting U.S. spending to the 10% level would save about $1 trillion per year. This would stop the drag on the real economy and improve our international competitiveness.

Any "reform" that does not aim for this goal is not real reform.

The best option is single payer. Second best is a strong public plan that can use all possible advantages to compete. There is no good third best.

And any reform must ensure that Americans pay no more for medications than people in, say, Canada or France by negotiation, use of generics, etc. In addition to eliminating excessive testing and all that. Full court press.

[quindy]

When is the mass media going to pick up this story?

[lvdragonlady]

Probably when h#** freezes over and not a minute sooner.

[pfrogger]

the public option be coming. no stopping it now.
Reconciliation. Strong public option, strip Repub amendments, remove mandates.
That's why the insurance shills/trolls are getting crazier. It's unstoppable.

anyone who can and wants to employ action instead of just rhetoric, be at AMERICANS UNITED FOR HEALTH CARE & INSURANCE REFORM RALLY & March in Washington , D.C. Sept. 13, 2009.
http://americansunitedhcr.wordpress.com/

how FDR rolled - http://www.nytimes.com/2009/09/03/opinion/03smith.html?adxnnl=1&adxnnlx=1252008229-iHieNzQgN025iNwGFLvoDg

[joebaggadonuts]

Excellent article to bring this issue out of the closet. Thank you Jamie.

Tort reform should not apply to faceless insurance companies who wrongfully deny coverage resulting in pain, suffering or death..

[DanBest]

Damn straight. Down here in Texas we call it "Tort Deform".

[steppenwolfsayshi]

Ooooo. I like your idea. The insurance company should have to publicize a rate of deaths, hospital bounce-backs and other bad outcomes occuring after a denial of service and be charged penalities for high rates and enventually not allowed to operate if rates become unacceptable.

[lightningbolt]

If health reform isn't passed with the public option or with single payer, we should organize mobs to take over the health insurance industry by force. If justice cannot be carried out by the government, then the people should carry it out. The health insurance companies are getting away with murder. This is a life and death situation.

[WorkingClass]

I keep saying - the insurance companies must be destroyed. Not regulated, not reformed and certainly not rewarded. DESTROYED !

Its them or us.

[FoonTheElder]

They serve no purpose except to take a big cut of health care money.

Insurance companies don't provide any health care, all they are is a very expensive way to provide funds for health care expenses.

[escribacat]

I agree.

[RN4MERCY]

Thanks for the call to action and accountability Jamie! Pacificare and Cigna are killing our chances at genuine health reform too. "Choose the plan that's right for you?" And to think there are those in Congress who want to mandate this form of manslaughter: death by spreadsheet.

As an RN, I'm angry and sad that we have to keep putting patients who should've lived in bodybags; patients who've died of preventable illnesses for lack of money to seek treatment and pay for medically necessary care. The problem isn't just with these insurers, it's all of them!

It's time to put these risky death assurance brokers out of the business. It's time we start demanding healthy public policy from our elected representatives. It's time we asserted our right to healthcare by implementing a MediCare for All healthcare system in this country, based on the single payer model.

[stevesweetman]

Calling claim denial rates "kill rates" is irresponsible. The article confuses claim denials with authorization denials and covered benefits. Inflammatory articles such as this simply fuel the fire with confusion without educating the audience about the real problem. Real productivity does not stem from irrational ignorance.

[phree]

Denying claims because providing care is not profitable has tanglible consequences for the insured. One of those consequences may likely be death. As someone who paid claims for big evil insurance co for 4 years, I can assure you that many whose claims were denied actually died. We were sued numerous times for the denials. In the end, the insured died and perhaps the family got a bit of cash. What does this have to do with health care?

It proves the money changing middlemen insurance cos are actually a hindrance to care.

I'll be working off the evil karma from working for these bast$#ds for the rest of my life. One way is to expose the evil.

[Ameriki]

The real problem is the Pay or Die system we have now. Are you one of the greedy people living off the misfortune of the rest of us? Forget public option insurance. We need public health care. Let the insurance companies die.

[Realization]

Actually, I find lies about "death panels", "socialist takeovers by government", quality of foreign health care systems, and the rest of the right wing rhetoric to be irresponsible. This is far more accurate. And "real productivity" in the for profit health insurance industry has absolutely nothing to do with providing health care for Americans. It is about profit and denying care. I'm all in favor of people getting rich by providing consumers with a good product at a good price. I see no value added at all from the health insurance industry.

And all the talk about tort reform should be redirected. I'm no big fan of lawyers. But this is another problem with insurance.

[HRGuru]

Death Panels, Part II

Part of the negotiation for stop loss coverage is what is called 'lasering.' The stop loss carrier will submit a bid for the cost of the stop loss insurance with the names of individuals (employees and dependents) 'lasered' or crossed off of coverage because they are high risk.

Example:: An employer provides a self-insured plan with a $2,000,000 lifetime maximum. The bid from the stop loss carrier comes back with two names 'lasered' one would not be covered beyond $1,000,000 and the other no coverage after $400,000 even though the plan has a lifetime maximum of $2,000,000. That means if either of those two individuals has claims in excess of the lasered amount the company must pay the difference up to the plan lifetime maximum.

Not only is this kind of situation one that causes employers to drop health care coverage, it also can put a business totally out of business. I have sat in renewal meetings when as many as 22 names were on the lasered list. What a massive burden for a company to take on. In addition, the company can't tell the employee any of this. If this isn't being on a death panel, I don't know what is and it's not just the death of an individual it could also be the death of a business for reasons not at all related to the business it does.

[DanBest]

Thanks. I wish we heard more of these stories because they are authentic issues. Meanwhile opponents of healthcare reform use no logic or reason, don't bother to acknowledge the problems and never have an actual real story to tell.

[HRGuru]

The real death panels, Part I

I am a veteran of real health plan death panels. I have served on many - all as part of negotiations over an employer health plan.

People with employer health insurance don't know is exactly how fragile that coverage is.

The first time I ever dealt with this was as HR manager for a business of1,600 employees and to 4,500 covered lives. About a month before negotiations a representative of our health carrier paid me a visit. He brought up an employee who had five children including two sets of twins. The most recent twins had been born in the current plan year. He asked me if I could speak with the employee and ensure they took permanent birth control measures to prevent any additional pregnancies because four of the five children were born as high-risk babies. The insurance rep told me it could affect our renewal rate by as much as a full percentage point.

On another occasion I worked for an employer that was self-insured. Self-insured employers agree to pay costs per covered individual up to a certain amount and then purchase 'stop-loss' coverage to cover expenses in excess of that set amount. The employer may agree to pay expenses up to $50,000 for each covered person (employee and dependents) and the stop loss would pay expenses in excess of that amount. The 'death panel' meets when it is time for renewal or a change of insurance administrator.