Sunday, September 06, 2009

Do 100% of private insurers' profits come from denial of claims?

By most accounts, private health insurers make about 30% profit for holding your money in reserve until it is needed to pay for medical bills. As David Waldman (KagroX at Daily Kos) so aptly tweeted:

Insurers don't provide care. They just finance it. Why are we supposed to be happy paying 30 points on that deal (to private insurers) when Medicare takes just 4?

But now a report out of the California Attorney General's office shows that:

PacifiCare denied 39.6% of claims this year, Cigna 32.7%, Health Net 30%, Kaiser Permanente 28.3% and Blue Cross 27.9%.

Holy shit. Can those 2 sets of numbers be put together?

Namely, if private insurers are making roughly 30% profit, and those same private insurers are denying 30% of all claims, then is it the case that 100% of private insurers profits come from denying claims to sick people?

I can see a situation in which those two number would not be put together -- namely what if those 30% of claims that are denied represented only say, 15% of the costs facing Health Net in a given year? But isn't it likely that the opposite is in fact true -- namely that private health insurers are likely to deny THE MOST EXPENSIVE claims -- in which case the private insurers would be insolvent if not for profiting off of the pain of others (whose claims they deny).

For their brilliant post highlighting the CA Attorney General's health care Report, Corrente has now being added to my blog roll.

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