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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SIX TRUTHS

Reclaiming power from those who abuse it often starts with telling the truth. And in "This Is How Authoritarians Get Defeated," MoJo's Monika Bauerlein unpacks six truths to remember during the homestretch of an election where democracy, truth, and decency are on the line.

Truth #1: The chaos is the point.

Truth #2: Team Reality is bigger than it seems.

Truth #3: Facebook owns this.

Truth #4: When we go to work, we're in the fight.

Truth #5: It's about minority rule.

Truth #6: The only thing that can save us is…us.

Please take a moment to see how all these truths add up, because what happens in the weeks and months ahead will reverberate for at least a generation and we better be prepared.

And if you think journalism like Mother Jones'—that calls it like it is, that will never acquiesce to power, that looks where others don't—can help guide us through this historic, high-stakes moment, and you're able to right now, please help us reach our $350,000 goal by October 31 with a donation today. It's all hands on deck for democracy.

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