MassHealth has higher claim denial rate than commercial insurers

by Brian Schwartz | 9:05 am, June 23, 2009 | Comments Off

From the Boston Globe:

The state government Medicaid plan known as MassHealth, which covers low-income patients who can’t afford insurance, was the slowest payer of health claims to Massachusetts doctors last year, averaging 56 days, and denied the highest share of claims, 23.8 percent, according to rankings set to be released today. …

…The rankings were prepared by Athenahealth Inc., a Watertown company that helps doctors handle billing and records electronically, in collaboration with the Physicians Practice management journal. …

On its ranking of “denial rates,” the percentage of claims rejected or sent back for rework, Tufts denied 4.9 percent, Harvard Pilgrim 5.4 percent, Fallon 5.7 percent, Blue Cross-Blue Shield 6.2 percent, and MassHealth 23.8 percent.

Read the whole article here.

Granted, some claims, such as fraudulent ones and those that do not fall under the specific insurance policy’s benefits, should be denied. But for the criticism I hear of commercial insurance companies denying claims, why do we not hear more complaints when government does the same?

Not to defend commercial insurance here, as they benefit from a tax code that discounts their plans, which shields them from competition. The point is that politicians should not be using policy to force us into dealing with any insurer.

(Hat tip, Pioneer Institute)

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