Insurance claim waste must stop

It is outrageous $15 billion a year is lost through inaccurate claims.


It's not surprising the nation's doctors blame insurance company inefficiency -- as well as bumbling -- for about $15 billion in wasted health care costs.

But what is shocking is that the waste pinpointed in an American Medical Association report occurred in one out of five insurance claims. One might expect a one or two percent error rate as all humans do make mistakes. A 20 percent error rate is outrageous.

The AMA's report looked at accuracy of claims processing, as well as timeliness, of the nation's seven largest health insurance companies. Coventry Health Care Inc. had the best rating at 88.41 percent followed by Health Care Service at 87.83 percent. Anthem Blue Cross Blue Shield was last among the nation's largest insurers with a 73.98 percent accuracy rating, the Chicago Tribune reported

The report concludes that if the claims were 100 percent accurate the result would be $15 billion in savings through efficiency and reduced costs.

Now, expecting 100 percent accuracy isn't realistic, but expecting only one or two errors out every 100 claims would seem to be reasonable. The insurance companies, in response, turned this on the doctors saying the claims process would be more accurate if physicians filed claims electronically.

Given the high error rate, there is clearly enough blame to cover all involved -- from the doctors to the medical administrators to the insurance companies.

The bottom line is that it is millions of patients who are picking up this $15 billion tab through higher insurance premiums and medical costs.

This has got to stop.

The problems can be fixed without government intervention and oversight.

It's about the companies establishing quality control levels and then taking the steps to achieve them. Consumers must also hold these companies accountable.


Use the comment form below to begin a discussion about this content.

Sign in to comment

Click here to sign in