A California nurses group said Tuesday the state's biggest private insurers deny nearly a quarter of all claims.

In its report, the California Nurses Association/National Nurses United said for the first three quarters of last year, seven of California's main insurers rejected almost 13 million claims, or 26 percent of claims submitted.

This is a slight drop from 2009, when the insurers rejected about 27 percent of all claims, the group said.
"These obscene rejection rates demonstrate one reason medical bills are a prime source of personal bankruptcies as doctors and hospitals will push patients and their families to make up what the insurer denies," union co-president DeAnn McEwen said in a statement.

The report comes the same day as the nurses group staged a mass protest against planned rate hikes by the insurer Blue Shield, which agreed to delay the premium increases by almost two months.

Rejected

For the first three quarters of 2010, the denial rates of California's seven largest insurers varied fairly widely, according to the report:

· PacifiCare - 44 percent
· Cigna - 40 percent
· Anthem Blue Cross - 27 percent
· HealthNet - 24 percent
· Blue Shield - 22 percent
· Kaiser Permanente - 20 percent
· Aetna - 6 percent

Anthem Blue Cross had the highest number of rejections, the nurses group said, rejecting about 6 million claims. Anthem was followed by Blue Shield, which denied about 2 million claims, CNA/NNU said.

The changes from last year varied, too, with Kaiser Permanente witnessing the biggest drop in rejections. The insurer denied 7 percent fewer claims in 2010 than in the year before, the nurses group said. Cigna saw the biggest increase, the report said, with denials up about 5 percent from 2009.

Insurers have disputed the report, however. According to The Bay Citizen, a spokeswoman for California Association of Health Plans, an insurance lobby, said Blue Shield's rejection rates were in the "single digits," and not 22 percent, as claimed by the CNA/NNU.

The nurses group said the discrepancy comes about because the insurance company only considers eligible claims in its analysis, whereas the CNA/NNU looks at all claims received, the Citizen said.

Since 2002, these firms rejected about 67.5 million claims, according to the nurses group.

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