Health Insurers Deny Up To A Third Of State Applicants

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Some Connecticut health insurers deny up to a third of the people who apply for individual coverage, an analysis of federal data shows.

Insurers who have the highest rate of denials are Anthem at 15 to 33 percent and Celtic Insurance Company, 31 to 33 percent, according to the data provided by insurers.

In more than 100 plans sold in Connecticut, denial rates range from 12 to 33 percent.  In some states, denial rates vary by region, but not in Connecticut.  The denial rates were identical in cities and towns.

A recent Government Accountability Office report said that nationally 19 percent of individuals who apply for health insurance are turned down.  The GAO report did not breakdown denials in Connecticut.

“Thank God that 2014 is coming,” said Vicki Veltri, the state’s Healthcare Advocate. In 2014, insurers will no longer be able to deny coverage because of pre-existing conditions, a provision of federal health care reform.

“It’s not a very good message, obviously,” Veltri said of the denial rates, but she added that the figures “raise more questions than they answer.”  For example, she would like to see the reasons behind the denials and know how many people could actually afford the plans for which they qualified.

Health insurers dispute the picture painted by the federal data. A study by the industry group America’s Health Insurance Plans puts the national denial rate at 10 percent, much lower than government estimates.

Robert Zirkelbach, a spokesman for the group, said that many people denied coverage under one plan succeed in getting it under another one. Denials can also come for logistical reasons, such as a person applying for coverage in a plan that does not serve their area, he said.

Zirkelbach defended the practice of denying coverage based on preexisting conditions so that people do not seek insurance “only when they get sick.”

The federal website allows consumers to type in their zip code and other information to see what insurance options might be available to them and what the denial rates are for each given policy.  The data is supplied by insurers to the U.S. Department of Health and Human Services.

Aetna’s denial rate ranged from 15 to 23 percent in Connecticut, depending on the plan. Connecticare is 23 percent and UnitedHealthOne, 12 to 21 percent, the data shows.

In 2010, 12.3 percent of Connecticut residents under age 65 did not have health insurance, according to the U.S. Census Bureau. That number has been climbing since 2006, when it was 9.39 percent.  The census found that 6 percent of children under 18 in the state had been uninsured for the previous 12 months.

Nationally, the uninsured rate for people under 65 is 18.4 percent.

One thought on “Health Insurers Deny Up To A Third Of State Applicants

  1. Perfect timing of this article as I’m writing out my “Health Reinsurance Association” check of almost $1600.00/month!  Yep, rejected by the individual plan but still covered by Unitedhealthcare at THIS ridiculous rate due a total thyroidectomy well over 5 years ago! (yeah, I KNOW that I’ll be on a medication ad infinitum but it’s less than $15.00/mo!) and btw, NO OTHER “HEALTH EPISODES” since then!
    PS: just an FYI for those needing information: this policy is restrictive…no proactive interventions (ie Bariatric interventions of ANY kind) to change the path of Type II DM (just ONE example!)