Who Denies the Highest Percent of Claims? Medicare.

This is from the 2008 Health Insurance Report Card released by the American Medical Association:

10_9 Denials_Chart 

Comments (12)

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  1. Brian W. says:

    The difference is Medicare only denies the coverage you don’t really need.

    Remember: Obama only wants to eliminate the health care that is unnecessary.

  2. Larry C. says:


  3. Devon Herrick says:

    The Left would have you believe that private insurers charge excessive premiums only to deny sick people the care they so desperately need. If these figures are typical, most insurers only deny between 3% and 4% of claims. This does not strike me as out of the ordinary since claims denied are a function of both insurers and providers. However, it is surprising that Medicare denies the highest percentage of the bunch.

  4. Linda Gorman says:

    The report also gives the reason the claims were denied. Aetna mostly denied them because they had already been paid. Medicare mostly denied them because a) there wasn’t enough information on the claim form or b) the payer decided that the procedure was not medically necessary.

  5. Charlie says:

    This made my Friday. Well actually it is kind of depressing, but interesting either way.

  6. Ken says:

    Hate to put it this way, but can we say that the “public plan” is the one that rations the most care?

  7. Jack says:

    Medicare has a lot more people so the fact it has more denials doesn’t say much

  8. Linda Gorman says:


    These are percentages. That means they are standardized for the number of people.

  9. beverly says:

    Thanks for putting this here, John.

    I thought you might want to reference my original post on this “Medicare revelation”, it’s here: http://www.hsabenefitsconsulting.com/blog then it took off on the internet when http://www.bigovernment.com picked it up.

    Since I found this report and posted it on October 5th, I have received many comments from doctors, patients, and clerical staff giving their accounts of how Medicare is inconsistent in claims denied and how the Medicare reps that they call seldom give the same answer.

    Here is an example:
    “Our practice had over $250,000.00 of outstanding claims that were clean claims that were denied for no reason other than government incompetence. We finally got CMS’s attention by informing our patients (we have a long waiting list) that we would place all of our patients on the waiting list indefinitely until we got paid for the surgeries we had already done.

    The patients began writing and calling and pressuring CMS. CMS offices accused us
    of fraud, and were dishonest to our patients by telling them it was our problem, not theirs. With help from Senator Pat Roberts, we were finally able to receive payment for these improperly denied claims. Our bariatric office staff spent 60% of their time for several months trying to resolve these issues. This was time away from processing
    new patients, and running the rest of our practice. This is one example of the horror stories that await all physicians when the government has absolute power of the purse.

    How many small businesses
    can afford to carry a quarter of a million dollars in accounts receivable for nine months? How many can afford the staff resources and lost revenue it took to sort this out?

    I have seldom witnessed such egregious practice in my surgical career.”

  10. beverly says:

    BTW: Daily Kos tried to debunk it (unsuccessfully) here. http://www.dailykos.com/story/2009/10/6/05110/6076

  11. John Goodman says:

    Thanks, Beverly. I should have given you a hat tip.

  12. S Tolbert says:


    What is the response to the Kos repudiation? I’ve not come across one yet. It appears that Kos might be correct on this one. Most of those denials from Medicare seem to be for technical issues, attempts at fraud, bad information, sent to the wrong place, etc. Etc. Also, the fact that a private insurer “approved” a claim but merely paid a dollar out of 20 on some claims is not quite on par with the fact that Medicare pays most bills for its many participants.

    I’m afraid so far this looks like a myth.

    As Kos points out, when you rightsize for the denial code, Medicare pays most everything legitimate based on need and not cost.