June 20--Health insurance companies are inaccurately processing nearly one in five medical claims, slowing payments to doctors and adding bureaucratic headaches to patients, the American Medical Association said this morning.
In its annual report card on the health insurance industry, released during the the group's annual House of Delegates meeting here, the AMA said commercial health insurance companies have an error rate of 19.3 percent, a two percentage increase from last year's report.
Improving claims processing could save patients money and improve medical care by reducing hassles physicians have when they are forced to haggle with health plans over payments or other issues. The AMA said the report is designed to hold insurance companies accountable.
"A 20 percent error rate among health insurers represents an intolerable level of inefficiency that wastes $17 billion annually," said Dr. Barbara McAneny, an AMA board member and medical oncologist from New Mexico. "Health insurers must put more effort into paying claims correctly the first time to save precious health care dollars and reduce unnecessary administrative tasks that take time and resources away from patient care."
The AMA's report measured timeliness and accuracy of claims processing of the nation's seven largest health insurers, including Aetna, Inc.; Humana Inc. UnitedHealth Group and Chicago-based Health Care Service Corp., parent of Blue Cross and Blue Shield of Illinois.
UnitedHealth had the best rating at 90.23 percent followed by Regence Group Blue Cross Blue Shield at 88.41 percent and then Health Care Service at Service at 87.04 percent. Anthem Blue Cross Blue Shield was last among the nation's largest insurers with a 61.05 percent accuracy rating, the AMA said.
The AMA report's findings are based on a random sample of about 2.4 million electronic claims for about 4 million medical services submitted in February and March of this year.
bjapsen@tribune.com
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