AMA: Bad Claims Payment Increasing

It's not your imagination. Most health insurers are getting worse at correctly paying physicians' claims, the American Medical Association says in its fourth annual National Health Insurer Report Card [PDF]. AMA reports that the overall rate of inaccurate claim payments has increased since 2010 among major commercial health insurers, wasting billions of dollars and frustrating patients and physicians.

AMA says its findings show that commercial health insurers have an average claims-processing error rate of 19.3 percent, a 2-percent increase over 2010. "The increase in overall inaccuracy represents an extra 3.6 million in erroneous claims payments compared to last year, and added an estimated $1.5 billion in unnecessary administrative costs to the health system," an AMA news release  said. AMA estimates eliminating claims-payment errors would save $17 billion. 

The news release says UnitedHealthcare was the only insurer to improve claims-processing accuracy. "UnitedHealthcare came out on top of seven leading commercial health insurers with an accuracy rating of 90.23 percent. Anthem Blue Cross Blue Shield scored the worst of those measured with an accuracy rating of 61.05 percent," the AMA said.

The report's key findings were mixed:

  • Physicians received no payment from insurers on nearly 23 percent of their claims.
  • Denial rates dropped dramatically since last year at Aetna, Anthem Blue Cross Blue Shield, Health Care Service Corporation, and UnitedHealthcare.
  • Although it had the lowest denial rate, CIGNA had the highest rate of claims requiring prior authorization.
  • CIGNA and Humana cut their median claims response time in half during the last four years. 

Action, July 5, 2011


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