AMA issues first health insurer report card

Increasingly, providers and their vendors have begun to rate insurance companies. This comes in part as a means of turning the tables on the insurers who, some say, have become far too focused on rating and ranking providers. The latest to enter the "rate your insurer" sweepstakes is now the American Medical Association, which issued its first health insurance report card yesterday at the group's annual meeting. The report card, part of the AMA's "Cure for Claims" campaign, attempts to document how much variability there is in health plan practices--and how much administrative cost these variations pump into the system.

To compile results, the report card compares payment rates for Medicare and seven national commercial health plans on how quickly and accurately they pay claims. Its results are based on a random sample taken from 3 million claims.

According to the AMA, claims denial rates among commercial health plans and Medicare vary widely, from less than 3 percent to nearly 7 percent. Worse, explanations of why denials took place differ a great deal as well, making it hard for professionals to respond in a uniform way. Another finding was that the insurers, as a group, reported the correct contracted payment rate from 62 to 87 percent of the time. And the AMA report card also noted that there's extremely wide variation among the payers as to how often they apply computer-generated edits to reduce payments, ranging from less than .5 percent to over 9 percent.

When it came to specific providers, UnitedHealthcare has the lowest rate of contract compliance, with about 62 percent of medical services billed paid by UHC at the contracted rate, compared with 98 percent for Medicare and 71 percent for Aetna. Medicare actually performed better than private insurers in most areas, in part because it isn't obliged to constantly prove to employer customers that it's being tough on costs, observers noted.

To learn more about the report card:
- read this Associated Press piece
- read this AMA press release

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