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AMA: Claims processed faster but patients pay quarter of bill Posted: July 7th, 2013

By Beth Orenstein

Beth Orenstein is a freelance writer from Northampton, Pa. A graduate of Tufts University, she covers health and insurance topics.

The American Medical Association's most recent report on health insurance companies found they are processing claims faster with fewer errors and better explanations. But the annual report also found that patients are paying nearly 25 percent of most claims out of pocket.

In its sixth annual National Health Insurance Report Card, the AMA found that the average error rate of health insurers when processing claims had fallen to 7.1 percent from 20 percent in 2010.

At 98.1 percent, Medicare had the highest accuracy rate, according the report. The public health insurance company with the best accuracy rate was UnitedHealthcare with 97.5 percent. Regence had the lowest with 85 percent.

Claims processed faster

The study found that insurers were processing claims 17 percent faster this year than they did in 2008. Humana had the fastest turnaround time at six days while the slowest were Aetna and Medicare at 14 days. Medicare's commercial claims turnaround time has remained at 14 days since 2008.

The number of claims denied also has declined. Of the claims filed in 2013, insurers refused to pay 1.82 percent, the report says. That's far fewer than the 3.48 percent they denied in 2012 when denials spiked. The company with the lowest denial rate was Cigna at 0.54 percent. Medicare denied more claims than the seven commercial insurers in the report. Medicare's denial rate was 4.92 percent.

Rules spelled out more clearly

The report also said that insurers are spelling out their rules more clearly to doctors, which saves them time and money when processing and resubmitting claims.

For the first time since it started issuing annual report cards, the AMA calculated how much of their medical bills patients are responsible for through co-pays, deductibles and co-insurance. They found patients paid an average 23.6 percent of the amount that health insurers set for paying physicians.

AMA: 'More transparency' needed

In a release on the report, AMA board member Barbara L. McAneny, MD, said, "The AMA is calling on insurers to provide physicians with better tools that can automatically determine a patient's payment responsibility prior to treatment."

The AMA's report card is based on about 2.6 million electronic claims submitted to eight large insurers in February and March for 4.7 million medical services. The eight insurers in the study were: Aetna, Anthem Blue Cross Blue Shield, Cigna, Health Care Service Corp., Humana, Regence, UnitedHealthcare and Medicare.

The claims in the study were from 450 doctor's offices representing 80 specialties in 41 states.