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 six largest insurers operating in
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
"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
"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
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.
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, which denied 28 percent of all claims in the first half of 2009, was one of two systems to reject options for radiation and chemotherapy for 57-year-old Bob Scott of
"He had been in perfect health all of his life. This was his first problem other than a sprained ankle. He died six months later."
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."
CNA/NNOC supports an alternative approach, expanding Medicare to cover all Americans, which would give the
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"The master class has always declared the wars; the subject class has always fought the battles. The master class has had all to gain and nothing to lose, while the subject class has had nothing to gain and everything to lose--especially their lives." Eugene Victor Debs