' Medicare led the group with the greatest percentage of insurance claims denied (6.85%), more than double the denial rate for private insurers like UHC (2.7%), Coventry (2.9%), Humana (2.9%) and CIGNA (3.4%). '

http://www.mrswing.com/articles/How_Do_We_Keep_Gov_t_Honest_Medicare_Denies_More_I.html

' Now the stats...do show Medicare with the most count of records {'policyholders'} but notice the closest to them in count of records was UHC which had the least amount of denied claims percentage wise out of them all by more than half of Medicare. So to argue that Medicare and a government ran ex-change co-op or public option will cause less denial in claims is unfounded when looking at the already government ran Medicare. '

http://www.valuesvoternews.com/2009/10/medicare-denies-more-claims-then.html

' Another reason for the differential claims denial rates is the demographics of Medicare and commercial insurance enrollees. Almost all Medicare enrollees are over 65, while commercial insurers have enrollees who are of varying ages. Since older individuals are more likely to demand high cost medical procedures, if high cost medical procedures are the ones that are more likely to be denied then Medicare’s higher denial rate may simply be due to the composition of its enrollees. '



{Good question. Let's keep in mind that all those - working and paying Medicare - includes citizens as patrons to all these private insurers and then some. Consider the relative size of the premium pools for certain private insurers to their claimants as alluded above from the second link and compare that relative to Medicare's ratio. Perhaps in some cases, larger insurers have less in administration costs relative to premiums coming in from a larger base and this could be why some larger insurers have a lower percentage of declines. Yet, also think of all the fraud and waste in Medicare and Medicaid which Obama claims one could carve out a whole new program. Maybe there needs to be a study (if not one already) between the types of claims by private insurers and Medicare and yield an average cost per claimant within a particular ailment class and see how that jives with denial percentages of the private insurers & Medicare to their aggregate premium bases -- especially before the Congress invokes reforms.}



' Whatever the reason, the fact that Medicare denies more claims than commercial insurers should dispel the myth that the government is simply a benevolent entity, while commercial insurers are ruthless, profit-hungry wolves. The truth as always lies not in the black nor the white but in the gray. '

http://healthcare-economist.com/2008/06/30/medicare-more-likely-to-deny-claims-than-commerical-health-insurers/