California Attorney General Jerry Brown has launched an investigation into how HMOs review and pay insurance claims submitted by providers in the state. The inquiry was prompted by reports that the state's five largest health insurers are denying insurance claims at rates of up to nearly 40%. “These high denial rates suggest a system that is dysfunctional, and the public is entitled to know whether wrongful business practices are involved,” Brown said in a written statement.
Brown probing HMOs' claims rejections
Earlier this week, the California Nurses Association released a report stating that six of California's largest health insurers rejected 22% of medical claims submitted by providers from 2002 through June 30, 2009.
Patrick Johnston, president and CEO of the California Association of Health Plans, said in a written statement that “a good deal of the so-called denials are merely paperwork issues between providers and plans and have little financial impact on consumers or impact the care received.”
What do you think? Post a comment on this article and share your opinion with other readers. Submit your comments to Modern Healthcare Online at [email protected]. Please be sure to include your hometown and state, along with your organization and title.
Send us a letter
Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.