Denial Management
Feb 16th, 2007 at 11:14 am by Maya
The most apt phrase in the universe. Krugman (via Truthout to avoid the stupid NYT Select charges) on the high price of insurance racketeering:
The two hospitals accuse UnitedHealth of operating a “rogue business plan” designed to avoid paying clients’ medical bills. For example, the suit alleges that patients were falsely told that Flushing Hospital was “not a network provider” so UnitedHealth did not pay the full network rate. UnitedHealth has already settled charges of misleading clients about providers’ status brought by New York’s attorney general: the company paid restitution to plan members, while attributing the problem to computer errors.
The legal outcome will presumably turn on whether there was deception as well as denial - on whether it can be proved that UnitedHealth deliberately misled plan members. But it’s a fact that insurers spend a lot of money looking for ways to reject insurance claims. And health care providers, in turn, spend billions on “denial management,” employing specialist firms - including Ingenix, a subsidiary of, yes, UnitedHealth - to fight the insurers.
So it’s an arms race between insurers, who deploy software and manpower trying to find claims they can reject, and doctors and hospitals, who deploy their own forces in an effort to outsmart or challenge the insurers. And the cost of this arms race ends up being borne by the public, in the form of higher health care prices and higher insurance premiums.
And not to beat this point to death, but:
To put these numbers in perspective: McKinsey estimates the cost of providing full medical care to all of America’s uninsured at $77 billion a year. Either eliminating the excess administrative costs of private health insurers, or paying what the rest of the world pays for drugs and medical devices, would by itself more or less pay the cost of covering all the uninsured. And that doesn’t count the many other costs imposed by the fragmentation of our health care system.
If this is truly such a feasible plan, which it appears to be since the numbers keep coming back this way, then the only conclusion we can really make about our lack of adequate healthcare is that lives are not as important as profits. Of course, this comes as no surprise to any of the readers here.
It doesn’t make it any less criminal, though. I would so love to see these guys get what’s coming to them.




Not to be the turd in the punch bowl, but this is, in fact, the same healthcare company which Tom Knox ran the PA division of before running for mayor. (Sorry to Susie M.)
Blue Cross/Blue Shield has been similarly sued in the past, although I don’t know what became of it.