Claim Denials Are Huge on Obamacare

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Via Andrew Sprung, here is a Kaiser analysis of data from Obamacare claims:

We find that, across issuers with complete data, 19% of in-network claims were denied by issuers in 2017, with denial rates for specific issuers varying significantly around this average, from less than 1% to more than 40%.

This is solely for providers on the federal exchange, but it matches data for California, which has its own exchange. Apparently there’s no data for employer insurance to compare this to, but a best guess suggests that the denial rate on Obamacare claims is at least twice that of private employer insurance.

This is fodder for critics of Obamacare on both the right and the left. It’s certainly one way in which health coverage via Obamacare is worse than private insurance, and it’s especially noteworthy given that so many Obamacare providers use narrow networks. After all, the whole point of narrow networks is that customers are forced to see only pre-screened doctors that the insurance company trusts not to overtreat.

At the same time, Medicare almost certainly has a much lower incidence of claim denial, which is yet another mark in favor of universal health care. It is really amazing the number of problems that could be solved by simply giving up the long twilight struggle that’s produced America’s insane patchwork of health care providers and insurers. Employers pay more than they have to, patients pay more than they have to, millions go without coverage at all, and those of us who do have coverage have to put up with terrible service. What an unholy mess.

HERE ARE THE FACTS:

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ONE MORE QUICK THING:

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As we wrote over the summer, traffic has been down at Mother Jones and a lot of sites with many people thinking news is less important now that Donald Trump is no longer president. But if you're reading this, you're not one of those people, and we're hoping we can rally support from folks like you who really get why our reporting matters right now. And that's how it's always worked: For 45 years now, a relatively small group of readers (compared to everyone we reach) who pitch in from time to time has allowed Mother Jones to do the type of journalism the moment demands and keep it free for everyone else.

Please pitch in with a donation during our fall fundraising drive if you can. We can't afford to come up short, and there's still a long way to go by November 5.

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