Three of Maryland's top health insurers have higher-than-average claim denial rates, according to a study that has gained traction following the fatal shooting of UnitedHealthcare CEO Brian Thompson and the arrest of Baltimore-area suspect Luigi Nicholas Mangione .
UnitedHealthcare, Maryland's third-largest health insurer by market share, ranked first in nonpayment, denying about a third, or 32%, of claims in 2022, according to an analysis by consumer research site ValuePenguin, a subsidiary of LendingTree.
The report showed that two of the other six top insurers in Maryland also had denial rates higher than the national average of 16%. These include BlueCross BlueShield, which does business in Maryland as CareFirst BlueCross BlueShield, with a denial rate of 17%, and Cigna Health Group, with a denial rate of 18%.
“The health insurance you have can affect how likely it is that your medical claim will be denied,” said a ValuePenguin post that appeared in May, months before UnitedHealthcare's Thompson on Dec. 4 in New York City was killed. “UnitedHealthcare, for example, disputes about a third of in-network claims.”
UnitedHealthcare questioned whether the claims rates were in circulation, but the company declined to comment specifically on ValuePenguin's numbers on Monday. Representatives for CareFirst and Cigna did not respond to requests for comment Monday.
A Dec. 6 update to ValuePenguin's research said the site had removed “certain data elements” from the post “at the request of law enforcement.”
The suspect in Thompson's death, Mangione, a Gilman graduate, faces five charges in New York, the most serious of which is second-degree murder, which in New York is roughly equivalent to Maryland's first-degree murder statute.
It was unclear which data elements were removed, but it appeared that the latest version of the post no longer includes a bar chart detailing companies' rejection rates. However, the tariffs shown in the graphic remain the same. ValuePenguin had also said in a December 5 update that “an insurer has contacted ValuePenguin claiming that the denial rate listed in this article does not match its internal records.”
Lending Tree, ValuePenguin's parent company, did not respond to questions about data removal or whether it was affiliated with the insurer that disputed its rate.
UnitedHealthcare said in a statement that about 90% of medical claims are paid upon submission and that only half a percent of claims requiring further review are flagged for medical or clinical reasons.
About half of the initially unpaid claims have administrative errors and can be corrected, while most of the remaining claims have issues such as lack of UnitedHealthcare coverage or duplicate claims, the statement said.
“All other numbers discussed in some circles that purport to affect UnitedHealthcare’s approval rating are false,” the statement said. “Highly inaccurate and grossly misleading information was disseminated regarding our company’s handling of insurance claims.”
Charts showing the ranking of denied insurance claims by company have been posted on social media on sites like Tumblr,
According to the National Association of Insurance Commissioners, UnitedHealth Group, parent company of UnitedHealthcare, has a nearly 17% market share in Maryland, while Carefirst Inc. has a nearly 34% share and Cigna has a 5% share. Kaiser Permanente, which had the lowest claim denial rate of any insurer at 7%, according to the ValuePenguin report, has more than 17% market share in Maryland.
ValuePenguin said it based its claim denial rates on publicly available denial and appeal data from the Centers for Medicare & Medicaid Services. The denial rates relate to claims within the network, the analysis says.
The consumer site said it downloaded publicly available files on March 1 with the data covering dates from January 1, 2022 to December 31, 2022. The most recent data was presented when the article was published in May.
The analysis also revealed the top reasons for claim denials, based on Experian's claims status report. 48% of claims are rejected because procedures were not pre-approved, 42% because doctors or hospitals were out of network and 42% because of billing code issues, the analysis said.
