Increasing Claim Denials and Higher Premiums On the Way; Fundamental Change Needed

Health Insurance Denied Form Showing Unsuccessful Medical Application

Denials of claims and increasing premiums are just the latest news California consumers have to look forward to.

This is not hyperbole. The California Department of Insurance has opened an investigation into allegations regarding Aetna’s practices of denying claims. The insurance commissioner did this after learning a former medical director for the insurer admitted under oath he never looked at patients’ records when deciding whether to approve or deny care.

This is not new. According to a study done by the California Nurses Association, the largest insurance companies denied 26 percent of all claims from 2002 to 2010. (The insurers stopped releasing such detailed information in recent years because of the media uproar.)

In addition, a new analysis by the Urban Institute shows that the Trump administration’s efforts to loosen health insurance rules will increase premiums for Obamacare plans by double-digit percentages in most states next year.

But California does have a choice.

In a recent Op-Ed, Deborah Burger, a registered nurse and co-president of the California Nurses Association/National Nurses United, explains  that with the Healthy California Act, SB 562, medical decisions would be based on patient need, not corporate profits.

“Savings from a single-payer system on funds insurers siphon off for profits — $27 billion the past five years — paperwork for care denials, and lucrative executive pay packages, along with the state’s ability to use its bulk purchasing power to lower drug costs will further reduce overall spending.

A CNA-commissioned study described additional revenues that would reduce what nearly every California family and business now pay for healthcare.”

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HEAL California is an independent news and information hub focused on the California Medicare for All movement. We feature non-partisan news, views, podcasts and videos that highlight the continuing failures of our broken healthcare system and elevate the voices of advocates and organizations fighting for change. 

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