Big Insurers Underspend On Medical Care, Senate Probe Finds

Posted on 03. Nov, 2009 by Editor in Provider News

Which big health insurance company did lawmakers single out? Is it the one that gives you the most denials trouble?

A US Senate probe confirms what many coders and billers have been suspecting all along — that six major medical insurers aren’t spending as much as they should providing actual health care.

Insurance industry officials say that all health insurers spend an average of 87 cents of every dollar on medical care, reports The Wall Street Journal. For the trade-group-curious, America’s Health Insurance Plans (AHIP) came up with the ‘87 cents’ figure.

And I bet you can tell me the names of the insurers that ‘underspend’ without reading the rest of the article. But just for grins — they’re Aetna Inc., Cigna Corp., Coventry Health Care Inc., Humana Inc., Unitedhealth Group Inc. and Wellpoint Inc., reports the Journal. These big fish spend an average of 74 cents on every dollar individuals pay in premiums on medical care (if they’re on individual plans). That figure goes up a bit for small group (80 cents). However, even the large group insurance average (84 cents) for these six insurers doesn’t hit AHIP’s estimate of how much premium money goes to actual medical care.

“The [Senate] report singles out Cigna, saying that it failed to report $5 billion in small group and large group insurance business to state regulators and instead reported it as “other group” business,” says the Journal.

AHIP, which provided the 87 cents figure, released a wordy statement that let the large insurers off the hook — basically, that the chunk of each dollar spent on actual medical care doesn’t tell much about how good the medical care is. More from the Journal …

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Tags: Aetna, AHIP, CIGNA, Coventry, Humana, insurer, Unitedhealth, Wellpoint