California's Real Death Panels: Insurers Deny 21% of Claims

Wed Sep 2, 2009 3:41pm EDT

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PacifiCare's Denials 40%, Cigna's 33% in First Half of 2009




OAKLAND, Calif., Sept. 2 /PRNewswire/ -- More than one of every five requests
for medical claims for insured patients, even when recommended by a patient's
physician, are rejected by California's largest private insurers, amounting to
very real death panels in practice daily in the nation's biggest state,
according to data released today by the California Nurses Association/National
Nurses Organizing Committee.

CNA/NNOC researchers analyzed data reported by the insurers to the California
Department of Managed Care. From 2002 through June 30, 2009, the six largest
insurers operating in California rejected 31.2 million claims for care - 21
percent of all claims.

The data will be presented by Don DeMoro, director of CNA/NNOC's research arm,
the Institute for Health and Socio-Economic Policy, at CNA/NNOC's biennial
convention next Tuesday, Sept. 8 in San Francisco. The convention will also
feature a panel presentation from nurse leaders in Canada, Great Britain, and
Australia exploding the myths about their national healthcare systems.

"With all the dishonest claims made by some politicians about alleged 'death
panels' in proposed national legislation, the reality for patients today is a
daily, cold-hearted rejection of desperately needed medical care by the
nation's biggest and wealthiest insurance companies simply because they don't
want to pay for it," said Deborah Burger, RN, CNA/NNOC co-president.

For the first half of 2009, as the national debate over healthcare reform was
escalating, the rejection rates are even more striking.

PacifiCare denied 40 percent of all California claims in the first six months
of 2009. Cigna, which gained notoriety two years ago for denying a liver
transplant to 17-year-old Nataline Sarkisyan of Northridge, Calif. and then
reversing itself, tragically too late to save her life, was still rejecting
one-third of all claims for the first half of 2009.

"Every claim that is denied represents a real patient enduring pain and
suffering. Every denial has real, sometimes fatal consequences," said Burger.

PacifiCare, for example, denied a special procedure for treatment of bone
cancer for Nick Colombo, a 17-year-old teen from Placentia, Calif. Again,
after protests organized by Nick's family and friends, CNA/NNOC, and netroots
activists, PacifiCare reversed its decision. But like Nataline Sarkisyan, the
delay resulted in critical time lost, and Nick ultimately died. "This was his
last effort and the procedure had worked before with people in Nick's
situation," said his older brother Ricky.

California Blues rejected 28 percent of claims in the first half of 2009. In
2008, six days before RN Kim Kutcher of Dana Point, Calif., was scheduled to
have special back surgery, Blue Cross denied authorization for the procedure
as "investigational" even though the lumbar artificial disc she was to receive
had FDA approval.

At the time of denial, which she calls "insurance hell," Kutcher notes she had
"already gone through pre-op testing, donated a unit of blood, had
appointments with four physicians." Kutcher paid $60,000 out of pocket for the
operation and is still fighting Blue Cross.

Kaiser Permanente, which denied 28 percent of all claims in the first half of
2009, was one of two systems to reject options for radiation and chemotherapy
for 57-year-old Bob Scott of Sacramento after his diagnosis of a brain tumor
in 2005. The reason cited was his age, says wife Cheryl Scott, RN. "He had
been in perfect health all of his life. This was his first problem other than
a sprained ankle. He died six months later."

Rejection of care is a very lucrative business for the insurance giants. The
top 18 insurance giants racked up $15.9 billion in profits last year. 

"The routine denial of care by private insurers is like the elephant in the
room no one in the present national healthcare debate seems to want to talk
about," Burger said. "Nothing in any of the major bills advancing in the
Senate or House or proposed by the administration would challenge this
practice."

"The United States remains the only country in the industrialized world where
human lives are sacrificed for private profit, a national disgrace that seems
on the verge of perpetuation," she said.

CNA/NNOC supports an alternative approach, expanding Medicare to cover all
Americans, which would give the U.S. a national system similar to what exists
in other nations. Data released in late August by the Organization for
Economic Co-operation and Development, which tracks developed nations, found
that among 30 industrial nations, the U.S. ranks last in life expectancy at
birth for men, and 24th for women.

CNA/NNOC represents 86,000 registered nurses in all 50 states, and is working
toward unification with the Massachusetts Nurses Association and United
American Nurses to build a new 150,000 member national nurses organization.


SOURCE  California Nurses Association/National Nurses Organizing Committee

Charles Idelson, +1-510-273-2246, Shum Preston, +1-510-273-2276, or Liz
Jacobs, +1-510-273-2232, all of California Nurses Association/National Nurses
Organizing Committee
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