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Insurers: White House In Denial About Coverage Denials

One of these days, White House!

The latest back-and-forth between the insurance industry and the Obama administration reminds us of The Honeymooners' domestic squabbling: There's always something to complain about.

In the latest episode, Obama's health officials published a sweeping amount of information on 4,000 individual insurance plans early today, a health law requirement they say will take consumers out of the dark when it comes to buying coverage. The data include plans' prices, descriptions of benefits, and -- to insurers' consternation -- estimates of how many applicants each plan rejects. It's all on HealthCare.gov.

"Unfortunately, the website uses a fatally flawed definition of denials that presents an inaccurate and misleading picture to consumers," Robert Zirkelbach, a spokesman for America's Health Insurance Plans, wrote in an e-mail to Shots. The site includes denials due to mistakes such as folks applying for plans in the wrong state, he said. It also includes applicants who ended up getting "counter-offers" for other coverage -- often at a different price.

Zirkelbach wasn't sure of how broad a problem this really is, but said the lobbying group thought it was "significant." Shots has a tough time believing vast numbers of people are trying to get coverage in the wrong place, but many insurers do offer look-alike plans in neighboring states.

How common are rejections? Depends on the plan. In Washington, D.C., UnitedHealth's plans tended to turn down only about 11 percent of applicants, while -- according to the site -- 67 percent were denied by some of Celtic Insurance Company's plans.

To back its argument that those numbers are inflated, AHIP points to the health department's own explanation of what counts as a "denial," and it does seem overly broad. An FAQ prepared by the department for insurers says, the "'Number applications denied' refers to the total count of attempts by applicants to enroll in the product."

Insurers submitted most of the info themselves -- on these forms. Zirkelbach complained that "our companies had to submit a tremendous amount of data in an extremely short time frame. Impressive that they were able to pull it off. Too bad the data is not being presented accurately."

Asked about AHIP's concern, Jessica Santillo, a health department spokeswoman said, the information about rejections "had never before been available to consumers" and would make insurers more accountable. She said denials include "people who were turned down; denied a policy until a pending medical procedure or test was concluded; and people who were denied the policy they applied for but offered a different plan."

All this comes on the heels of a White House outburst over the Wall Street Journal's implication that the health law was pushing premiums up by 1 percent to 9 percent. Health Secretary Kathleen Sebelius said her office has "zero tolerance" for insurers that say they are increasing premiums because of the law. Pow, right in the kisser, AHIP.

Copyright 2023 Kaiser Health News. To see more, visit Kaiser Health News.

Christopher Weaver and Jessica Marcy
Up North Updates
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