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

On Friday, the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC) issued a press release analyzing data reported by the insurers to the California Department of Managed Care. More than 1/5 of all claims were denied, according to the report.

From 2002 through June 30, 2009, the six largest insurers operating in California rejected 31.2 million claims for care or 21% of all claims. The press release goes on to detail examples:

Kaiser Permanente (28% denial rate in the first half of 2009): 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, according to wife Cheryl Scott, RN.

Cigna, famously denied a liver transplant for 17-year-old Nataline Sarkisyan of Northridge, CA and then reversed itself, albeit too late to save her life, in 2007. They are still rejecting one-third of all claims for the first half of 2009.

PacifiCare denied 40% of claims in the first half of 2009. It denied a special procedure for the treatment of bone cancer for Nick Colombo, a 17-year-old teen from Placentia, CA. as in Sarkisyan's case, PacifiCare reversed its decision after much bad PR. Also like Nataline Sarkisyan, the delay cost time, and he ultimately died.

California Blue Cross rejected 28% 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, the company denied authorization for the procedure as "investigational" even though the lumbar artificial disc she was scheduled to receive had FDA approval.

Deborah Burger, RN, CNA/NNOC co-president said (emphasis mine):

"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. 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."

CNA/NNOC has long supported expanding Medicare to cover all Americans. According to dData released in late August by the Organization for Economic Co-operation and Development, which tracks developed nations, among 30 industrial nations, the U.S. ranks last in life expectancy at birth for men, and 24th for women.