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.

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Which is also a pretty great way to describe Mother Jones' mission: People coming together around the truth to hold power accountable.

And right now, we need to raise about $400,000 from our online readers over the next two months to hit our annual goal and make good on that mission. Read more about the information war we find ourselves in and how people-powered, independent reporting can and must rise to the challenge—and please support our team's truth-telling journalism with a donation if you can right now.

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