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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THE FACTS SPEAK FOR THEMSELVES.

At least we hope they will, because that’s our approach to raising the $350,000 in online donations we need right now—during our high-stakes December fundraising push.

It’s the most important month of the year for our fundraising, with upward of 15 percent of our annual online total coming in during the final week—and there’s a lot to say about why Mother Jones’ journalism, and thus hitting that big number, matters tremendously right now.

But you told us fundraising is annoying—with the gimmicks, overwrought tone, manipulative language, and sheer volume of urgent URGENT URGENT!!! content we’re all bombarded with. It sure can be.

So we’re going to try making this as un-annoying as possible. In “Let the Facts Speak for Themselves” we give it our best shot, answering three questions that most any fundraising should try to speak to: Why us, why now, why does it matter?

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