HMO claims-rejection rates trigger state investigationCalifornia Atty. Gen. Jerry Brown is joining state regulators in scrutinizing the payment practices of seven major health plans in response to complaints from physicians and hospitals. California Atty. Gen. Jerry Brown is joining state regulators in scrutinizing how HMOs review and pay insurance claims submitted by doctors, hospitals and other medical providers. His announcement came Thursday as regulators said they had stepped up scrutiny of the payment practices of the state's seven largest health plans in response to complaints from physicians and hospitals.
The increased attention also comes on the heels of a first-of-its-kind report issued this week that said the California health insurers reject 1 in 5 medical claims. Six of the state's largest insurers rejected 45.7 million claims for medical care, or 22% of all claims, from 2002 to June 30, 2009, according to the California Nurses Assn.'s analysis of data submitted to regulators by the companies.
The rejection rates ranged from a high of 39.6% for PacifiCare to 6.5% for Aetna for the first half of 2009. Cigna denied 33%, and Health Net 30%. Anthem Blue Cross, the state's largest for-profit health plan, and Kaiser, the state's largest nonprofit plan, each rejected 28% of claims.
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http://www.latimes.com/business/la-fi-insure4-2009sep04,0,4503502.story Consumer group says UnitedHealth, Wellpoint broke Calif. labor codeA Santa Monica group has urged California Attorney General Jerry Brown to probe whether the nation’s two largest health insurers have asked their workers to lobby Congress — during business hours — to weaken health reform. Consumer Watchdog on Wednesday said in a letter to Brown that Minnetonka-based UnitedHealth Group Inc. (NYSE: UNH) and Wellpoint Inc. (NYSE: WLP) of Indianapolis have launched national campaigns to individually “assist” employees in writing and calling members of Congress. The coercion, the Santa Monica group states, is illegal under the California Labor Code.
UnitedHealth described the accusation, and others like it, as "particularly disappointing."
"We have stressed repeatedly that we strongly support bipartisan reform to modernize health care and improve access to quality care on a sustainable basis for all Americans," UnitedHealth said in a statement. The company added that the company gave employees information to voluntarily contact elected officials, and that workers were told to participate as individuals, not on behalf of the company.
Santa Monica-based Consumer Watchdog provided a copy of the letter that UnitedHealthcare sent to 75,000 employees. Media reports state the note was addressed from the company’s executive vice president and chief of medical affairs, Reed Tuckson. The note urges employees to speak to an advocacy group. Anthem’s note asks employees to write or call Congress and encourage them to “pass responsible and sustainable health care reform.”
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