Data Shows Health Insurance Denial Rates Routinely 20%

Bad News Regarding Your Health Insurance

USA Today posts an article on data compiled by the Department of Health and Human Services (HHS) pursuant to the recently passed health care law, showing the denial rates for health insurance.  Using this data a Government Accountability Office study of 459 insurers published earlier this year found an average of 19% of applicants nationally were denied coverage.  The study showed a wide range of denial rates.  A quarter of insurers had denial rates of 15% or below and a quarter had rates of 40% or higher.

The article noted that a House Energy and Commerce Committee investigation into four large for-profit insurers last year found that the denial rates have steadily increased from 11.9% in 2007 to 15.3% in 2009. The companies reviewed were Aetna, Humana, UnitedHealthcare and WellPoint.

The article quotes Kentucky resident Amanda Hite who says she felt “really healthy” when she applied recently for health insurance. But Anthem Blue Cross and Blue Shield denied her, because she had seen a chiropractor a few months earlier for a sore back and later had visited an emergency room because of back pain.  Hite’s case isn’t unusual. Many of the plans offered by Anthem Blue Cross in Kentucky reject about one in five applicants, according to data provided by insurers to the HHS. Rival insurers in the state have even higher denial rates: Humana rejects 26% to 39% of applications in Kentucky, while UnitedHealthcare denies 38% to 43%.

This is yet another example of how insurance companies seek to avoid risk.  Health insurance companies only want to insure healthy people who don’t use their benefits.  Car insurance companies only want to insure people who don’t get into accidents.  The difference?  Well, most states require insurance companies to offer minimum car insurance, while also requiring all drivers to have this minimum insurance.  Health insurance companies for the most part were not so obligated.  However, the recent Health Care Law bans health insurance companies from denying coverage for health reasons starting in 2014.

Insurance companies are in the risk business.  The more risk a person has, the more premiums that person will pay to offset the risk the insurance company takes on by insuring that person.  Mandatory insurance requirements favor consumers, because they inherently spread the risk among a larger group of people, while denying insurance companies the luxury of cherry picking only those consumers who carry the lowest risk.