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California Insurers Denied Over 26% of All Claims in 2009

Press Release Press Release, 2/25/10

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For Immediate Release
February 25, 2010

Denial Rates Continued to Climb Even After Public Uproar

Seven of California’s biggest insurance companies rejected more on average more than one-fourth of all payment claims in the second half of 2009, according to new data just released by the California Nurses Association/National Nurses Organizing Committee and its national arm, National Nurses United.

Denial rates continued to soar even after a public uproar last September following CNA/NNOC’s release of publicly available showing from 2002 through the first half of 2009, denials had averaged 22 percent.

Those reports prompted an investigation by California Attorney General Jerry Brown who late Thursday announced he would subpoena records from seven of the state’s biggest private insurance companies to review their policies that have led to public outrage over denials of claims and huge rate increases.

According to new data now announced by  CNA/NNOC from its research arm, the Institute for Health and Socio-Economic Policy – also based on publicly available data from the California Department of Managed Care denial rates for the last six months of 2009, averaging 26 percent for seven large insurers.

Claims denial rates by leading California insurers, second  half of 2009:

  • PacifiCare --  41.17%  
  • Cigna – 35.43 percent  
  • HealthNet – 25.82 percent  
  • Kaiser Permanente – 26.96 percent  
  • Anthem Blue Cross – 24.5 percent  
  • Blue Shield – 22 percent 
  • Aetna -- 6.4 percent 

 “What we see over and over is an arrogant industry that is indifferent to the pain and suffering caused by routine care denials or economic catastrophe prompted by outrageous price gouging,” said CNA/NNOC Co-President Geri Jenkins.

“The denials and pricing practices are both motivated by the prime directive  that seems to surpass everything else for these companies --  squeezing their patients and providers alike for profits and revenues regardless of who gets hurt along the way.”

“We applaud the effort of the Attorney General to more carefully scrutinize the behavior and records of the insurers. They must be held accountable to the public for their disgraceful and potentially illegal behavior,” Jenkins said.

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