Tuesday, June 17, 2008

Transparency and Accountability: The Door Swings Both Ways--AMA Releases Its "National Health Insurer Report Card"

You have to wonder what they're thinking about over at AHP--the health insurance trade association that called for more transparency and accountability for the provider community a few days ago--now that the American Medical Association's (AMA) detailed report card on insurer claim processing performance is out.

And, it's a fascinating read.

How often do health plans pay at the contracted payment rate?

"On what percentage of records does the payer's allowed amount equal the contracted payment rate?"
The AMA says health plans accuracy rates are:
  • United Healthcare registered a score of 61.55%
  • Cigna scored 66.23%
  • Aetna came in at 70.78%
  • Anthem (Wellpoint) scored 72.14%
  • Humana came in at 84.20%
  • Coventry was the best at 86.74%
Well, Coventry was the best except for Medicare, which the AMA said scored a 98.12%. So much for the for-profit model doing a better job than all those bureaucrats.

Medicare was the slowest on turnaround time for receiving and responding to a claim (14 days) and had the highest denial rate (6.9%), however.

You can see the entire report and the methodologies on the AMA site. The insurer comparison doc is labeled, National Health Insurer Report Card.
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