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

[depakid]

On Friday, the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC) issued a press release analyzing data reported by the insurers to the California Department of Managed Care. More than 1/5 of all claims were denied, according to the report.

From 2002 through June 30, 2009, the six largest insurers operating in California rejected 31.2 million claims for care or 21% of all claims. The press release goes on to detail examples:

Kaiser Permanente (28% denial rate in the first half of 2009): one of two systems to reject options for radiation and chemotherapy for 57-year-old Bob Scott of Sacramento after his diagnosis of a brain tumor in 2005. The reason cited was his age, according to wife Cheryl Scott, RN.

Cigna, famously denied a liver transplant for 17-year-old Nataline Sarkisyan of Northridge, CA and then reversed itself, albeit too late to save her life, in 2007. They are still rejecting one-third of all claims for the first half of 2009.

PacifiCare denied 40% of claims in the first half of 2009. It denied a special procedure for the treatment of bone cancer for Nick Colombo, a 17-year-old teen from Placentia, CA. as in Sarkisyan's case, PacifiCare reversed its decision after much bad PR. Also like Nataline Sarkisyan, the delay cost time, and he ultimately died.

California Blue Cross rejected 28% 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, the company denied authorization for the procedure as "investigational" even though the lumbar artificial disc she was scheduled to receive had FDA approval.

Deborah Burger, RN, CNA/NNOC co-president said (emphasis mine):

"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. 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."

CNA/NNOC has long supported expanding Medicare to cover all Americans. According to data released in late August by the Organization for Economic Co-operation and Development, which tracks developed nations, among 30 industrial nations, the U.S. ranks last in life expectancy at birth for men, and 24th for women.

[MadMaddie]

1. Hunh but we won't hear this on MSM will we?

[valerief]

3. It would be swell if President Obama told America these stories. nt

[depakid]

4. I can't think of a more horrible boogeyman to set up and focus anger and resentment on

And that's one of the most effective ways that policy is driven in America.

[snake in the grass]

16. Yes, it would, but...

...he might upset the Republicans and that's something he just doesn't want to do.

[Cha]

19. Bullshit..just stop the fucking

bullshit.

[Cha]

20. Bullshit..just stop the fucking

bullshit. Yeah, I'll say it again.

[valerief]

2. Brain tumor treatment was denied for a 57-year-old because of his AGE????

WTF????

What kind of a reason is that???????????

[Joe Bacon]

5. Reason: it wasn't cost-effective.

What other business can kill people on a regular basis and get away with Murder By Spreadsheet? These racketeers make Tony Soprano look like Mary Poppins!

[depakid]

6. "What other business can kill people on a regular basis and get away with Murder By Spreadsheet?"

Meat packers and the food processing industry.

Remember Peanut Corp of America? Got away with murder- and as yet, Obama's "Justice" Department has done zilch to hold anyone accountable.

[lunatica]

8. You get it. And it's really sad that this happens.

In truth, without DU and people like you and Keith Olbermann I wouldn't know this was happening. And thanks to Maxine Waters.

[Joe Bacon]

9. Thanks for the kind words

Been getting a lot of nasty flack lately for telling the truth here.

[Hissyspit]

14. But, but... there are so many HORROR stories coming out of Canada!

Made-up horror stories, but nonetheless, we can't have health care for everyone!

[Vinnie From Indy]

7. These are the stories that should be routinely used by Dem Politicians

The issue of having claims denied by insurers is being buried in the press. They want nothing to do with stories like this.

[andym]

10. This story and its sources should be faxed out today to leading politicians involved in health care

It's amazing that this story-- which should have been used by progressives and liberals to promote health care reform -- is buried here at DU as well as in the media.

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

It's too bad that the data (behind their analysis) won't be available til Tuesday Sept 8. Sending the original data to Representatives would be more effective.

[joeycola]

17. I will make it a mission to do so today. Hope ALL will do this.

[Triana]

11. That's where my Mom and sister live and BOTH have had hideous insurance problems

there.

I'm not surprised.

[avaistheone1]

12. This is pretty shocking.

Kudos for Jerry Brown going after this.

[valerief]

15. Seconded. nt

[boppers]

13. Whoa.

I knew there was a pile of bullcrap, fraud, and snake oil out there, but it can't be 21%, and some of the cases cites make for pretty shocking reading.

[TomCADem]

18. Any Major Media Coverage? I Guess They'd Rather Cover RW Parents Complaining

About President Obama's stay in school speech.

[dkf]

21. Nothing in the bill covers denial of care? I KNEW IT.

The moral of the story is that having health insurance is a hit or miss proposition. You simply can't count on it.

[boppers]

22. Denial of "care" is needed... to a point.

"Pyramid healing towers", for example, would be a waste of money.

I am a bit surprised that this debate isn't part of the discussion, though.

[oasis]

23. "The routine denial of care by insurers is like the elephant in the room..."

Let the truth be told. :kick:

[depakid]

24. "Let the truth be told."

How about let's tell it right....