California's Real Death Panels: Insurers Deny 21% of Claims

WASHINGTON - More than one of every five requests for medical claims for
insured patients, even when recommended by a patient's
physician, are rejected by California's largest private
insurers, amounting to very real death panels in practice daily
in the nation's biggest state, according to data released today
by the California Nurses Association/National Nurses Organizing
Committee.

CNA/NNOC researchers analyzed data reported by the insurers
to the California Department of Managed Care. From 2002 through
June 30, 2009, the six largest insurers operating in California
rejected 31.2 million claims for care – 21 percent of all
claims.

The data will be presented by Don DeMoro, director of
CNA/NNOC's research arm, the Institute for Health and
Socio-Economic Policy, at CNA/NNOC's biennial convention next
Tuesday, Sept. 8 in San Francisco. The convention will also
feature a panel presentation from nurse leaders in Canada, Great
Britain, and Australia exploding the myths about their national
healthcare systems.

"With all the dishonest claims made by some politicians about
alleged 'death panels' in proposed national legislation, the
reality for patients today is a daily, cold-hearted rejection of
desperately needed medical care by the nation's biggest and
wealthiest insurance companies simply because they don't want to
pay for it," said Deborah Burger, RN, CNA/NNOC co-president.

For the first half of 2009, as the national debate over
healthcare reform was escalating, the rejection rates are even
more striking.

PacifiCare denied 40 percent of all California claims in the
first six months of 2009. Cigna, which gained notoriety two
years ago for denying a liver transplant to 17-year-old Nataline
Sarkisyan of Northridge, Calif. and then reversing itself,
tragically too late to save her life, was still rejecting
one-third of all claims for the first half of 2009.

"Every claim that is denied represents a real patient
enduring pain and suffering. Every denial has real, sometimes
fatal consequences," said Burger.

PacifiCare, for example, denied a special procedure for
treatment of bone cancer for Nick Colombo, a 17-year-old teen
from Placentia, Calif. Again, after protests organized by Nick's
family and friends, CNA/NNOC, and netroots activists, PacifiCare
reversed its decision. But like Nataline Sarkisyan, the delay
resulted in critical time lost, and Nick ultimately died. "This
was his last effort and the procedure had worked before with
people in Nick's situation," said his older brother Ricky.

California Blues rejected 28 percent of claims in the first
half of 2009. In 2008, six days before RN Kim Kutcher of Dana
Point, Calif., was scheduled to have special back surgery, Blue
Cross denied authorization for the procedure as
"investigational" even though the lumbar artificial disc she was
to receive had FDA approval.

At the time of denial, which she calls "insurance hell,"
Kutcher notes she had "already gone through pre-op testing,
donated a unit of blood, had appointments with four physicians."
Kutcher paid $60,000 out of pocket for the operation and is
still fighting Blue Cross.

Kaiser Permanente, which denied 28 percent of all claims in
the first half of 2009, was one of two systems to reject options
for radiation and chemotherapy for 57-year-old Bob Scott of
Sacramento after his diagnosis of a brain tumor in 2005. The
reason cited was his age, says wife Cheryl Scott, RN. "He had
been in perfect health all of his life. This was his first
problem other than a sprained ankle. He died six months
later."

Rejection of care is a very lucrative business for the
insurance giants. The top 18 insurance giants racked up $15.9
billion in profits last year.

"The routine denial of care by private insurers is like the
elephant in the room no one in the present national healthcare
debate seems to want to talk about," Burger said. "Nothing in
any of the major bills advancing in the Senate or House or
proposed by the administration would challenge this practice."

"The United States remains the only country in the
industrialized world where human lives are sacrificed for
private profit, a national disgrace that seems on the verge of
perpetuation," she said.

CNA/NNOC supports an alternative approach, expanding Medicare
to cover all Americans, which would give the U.S. a national
system similar to what exists in other nations. Data released in
late August by the Organization for Economic Co-operation and
Development, which tracks developed nations, found that among 30
industrial nations, the U.S. ranks last in life expectancy at
birth for men, and 24th for women.