California Nurses: California's Real Death Panels: Insurers Deny 21% of Claims

[Better Believe It]

News Release
For Immediate Release
September 2, 2009

California's Real Death Panels: Insurers Deny 21% of Claims
PacifiCare's Denials 40%, Cigna’s 33% in First Half of 2009

More than one of every five requests for medical claims for insured patients, even when recommended by a patient's physician, are rejected by California's largest private insurers, amounting to very real death panels in practice daily in the nation's biggest state, according to data released today by the California Nurses Association/National Nurses Organizing Committee.

CNA/NNOC researchers analyzed data reported by the insurers to the California Department of Managed Care. From 2002 through June 30, 2009, the five largest insurers operating in California rejected 31.2 million claims for care -- 21 percent of all claims.

The data will be presented by Don DeMoro, director of CNA/NNOC's research arm, the Institute for Health and Socio-Economic Policy, at CNA/NNOC's biennial convention next Tuesday, Sept. 8 in San Francisco. The convention will also feature a panel presentation from nurse leaders in Canada, Great Britain, and Australia exploding the myths about their national healthcare systems.

"With all the dishonest claims made by some politicians about alleged 'death panels' in proposed national legislation, the reality for patients today is a daily, cold-hearted rejection of desperately needed medical care by the nation's biggest and wealthiest insurance companies simply because they don't want to pay for it," said Deborah Burger, RN, CNA/NNOC co-president.

For the first half of 2009, as the national debate over healthcare reform was escalating, the rejection rates are even more striking.

PacifiCare denied 40 percent of all California claims in the first six months of 2009. Cigna, which gained notoriety two years ago for denying a liver transplant to 17-year-old Nataline Sarkisyan of Northridge, Calif. and then reversing itself, tragically too late to save her life, was still rejecting one-third of all claims for the first half of 2009.

"Every claim that is denied represents a real patient enduring pain and suffering. Every denial has real, sometimes fatal consequences," said Burger.

PacifiCare, for example, denied a special procedure for treatment of bone cancer for Nick Colombo, a 17-year-old teen from Placentia, Calif. Again, after protests organized by Nick's family and friends, CNA/NNOC, and netroots activists, PacifiCare reversed its decision. But like Nataline Sarkisyan, the delay resulted in critical time lost, and Nick ultimately died. "This was his last effort and the procedure had worked before with people in Nick's situation," said his older brother Ricky.

California Blue Cross rejected 28 percent of claims in the first half of 2009. In 2008, six days before RN Kim Kutcher of Dana Point, Calif., was scheduled to have special back surgery, Blue Cross denied authorization for the procedure as "investigational" even though the lumbar artificial disc she was to receive had FDA approval.

At the time of denial, which she calls "insurance hell," Kutcher notes she had "already gone through pre-op testing, donated a unit of blood, had appointments with four physicians." Kutcher paid $60,000 out of pocket for the operation and is still fighting Blue Cross.

Kaiser Permanente denied 28 percent of all claims in the first half of 2009.

Rejection of care is a very lucrative business for the insurance giants. The top 18 insurance giants racked up $15.9 billion in profits last year.

"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," Burger said. "Nothing in any of the major bills advancing in the Senate or House or proposed by the administration would challenge this practice."

“The United States remains the only country in the industrialized world where human lives are sacrificed for private profit, a national disgrace that seems on the verge of perpetuation," she said.

http://www.calnurses.org/media-center/press-releases/2009/september/california-s-real-death-panels-insurers-deny-21-of-claims.html

[Oregone]

1. Yes. But we can't do it without these insurers. They have the experience

Lets design a system where we mandate Americans enroll in services these insurers offer. Then, well, since they are incredibly inefficient and executives need big pay, we can subsidize the premiums out of the government coffers. That way, we can guarantee these experienced and benevolent companies have a strong stream of new business, and their shares continue to go up.

[TheBluestEye]

2. If the insurers want the right to deny coverage, why are they opposed to a public option?

This is what I do not understand. Many of the people that would opt for public coverage are either un-insurable or cannot afford insurance. I do not see how the insurance companies lose.

[Jennicut]

3. They are greedy bastards who don't want any competition, even if that

competition will cover the people they won't?

[TwilightGardener]

6. They merely want people steered their way, paying premiums.

They want to collect your money, everybody's money, and then not pay out. That's the goal of all types of insurance, the very nature of the beast.

[area51]

4. This no doubt is part of the figure of

100,000 people dying in the U.S. per year due to lack of healthcare.

[TwilightGardener]

5. The more rejected claims, the more profit. Which is why it's fox guarding henhouse

to entrust our health care (and our lives) to these greedy heartless bastards.

[uponit7771]

7. K&R Saved & Bookmarked!!!

[nightgaunt]

8. The benefits of the free enterprise system, Libertarians rejoice!

Well there you have it in black and white and don't expect Glenn Beck or any of the other "deathers" from talking about it this way. Not when they are afraid to change and lose their lousy coverage. Where the bottom line isn't life but death! Wow, I wonder about James Dobson and the rest of those "lifers" on actually birthed people having their "Life, Liberty and Pursuit of Happiness" continued by actually living! Something that President Obama is firmly behind our present system. He actually wants to make it mandatory for all of us to be covered. But it must be through the Health Insurance system, the gov't will pick up the tab for the rest of us who can't afford the cost. Nice! Fascist Healthcare! What will he think of next as we pragmatically change from a republic into something Glenn Beck isn't saying we are headed to.

For Libertarians it is pay to play in the game of life. A meritocracy by their rules. If you aren't earning enough money to afford to live and thrive it is totally your fault and good riddance to lazy rubbish when you die. Cold hearted but that is the way they roll. The fascists among them also want gov't sponsored bailouts and no Bill of Rights. A marriage made in Hell, we get to be stepped on. mazolta! When the actuarials trump the physician it is a deadly day for you and me.

With so many things going on and we are being sold down the river Styx by our smiling, affable stooge and agent of the cabal, Barak H. Obama. The replacement for the previous stooge and agent of the cabal. Just he, Obama, can for a time push through what a Bush or McCain would have a little more trouble doing. Just like what Clinton did to us before. Remember NAFTA, GATT, WTO and the rest? It is happening again. Obama needs to be pressured at least to have the 1/2 assed Public Option. Poor though it is at least people will get the coverage they can't afford. That is what is important.

[PA Democrat]

9. Am I the only one who is EXTREMELY skeptical of insurance companies promises to change their

corrupt money-grubbing ways? What will they consider "reform"? Denying a mere 15% of overall claims instead of their usual 21%?

Thanks for posting this link. I am bookmarking it for future use.

[Vidar]

10. Excellent reference. Recommended.