AMA Comes Out With Insurance Report Card

WASHINGTON -- The U.S. health insurance system had a checkup from the American Medical Association, which looked at how often insurers delay, deny or reduce payments to doctors.

Its conclusion: doctors face a "chaotic payment system that takes countless hours away from patient care."

The National Health Insurer Report Card looked at eight insurers: Aetna, Anthem Blue Cross and Blue Shield, CIGNA, Coventry Health Care, Health Net, Humana, United Healthcare, and Medicare.

In a key category - percentage of times insurers paid out claims in full at the contracted rate - the best performer was: Medicare, at 98 percent. The worst performer according to AMA: United Healthcare, at 62 percent.

A United Healthcare spokesperson said claims processing is a joint responsibility of insurers and physicians.

That view is shared by an insurance industry trade group.

"The claim needs to be filed in the right way and the insurer needs to process it in the right way,” said Susan Pisano with America's Health Insurance Plans.

Pisano said late paperwork and mistakes by doctors are also to blame and that insurers are getting better as they move to electronic processing.

"Pretty close to all the clean claims that are put forward by physicians are paid within 30 days,” Pisano said.

AMA agreed doctors must do their part to cure the system. It said if all sides work together, that could save hundreds of billions of dollars a year. Those are savings AMA said could go to patient care.

As for outright denials of insurance claims - the AMA said those ranged from about three percent to about 7 percent among insurers. But the reasons given for denials varied a lot, ranging from incomplete paperwork from doctors to denial for a preexisting condition.

AMA report blamed insurers for what it said was inconsistency in the way the denial codes are applied and explained. It also blamed the doctor’s offices for making mistakes, causing insurers to kick paperwork back, and called on everybody to work to make the process easier to understand and more efficient.

To see AMA's complete insurer report card, visit the Association's Web site.

Link: National Health Insurer Report Card