According to the KFF, an independent source for health policy research, the state's largest insurer, Blue Cross Blue Shield (BCBS) of Alabama, had the highest initial denial rate in the country, with a 35% denial rate of in-network claims, or 4,533,017 initial denials.
BCBS of Alabama director of corporate communications and community relations Sophie Martin told 1819 News the numbers were misleading because they included claims that were eventually corrected and processed. Martin said the total claims denial rate is much lower, around 6%.
The KFF study showed UnitedHealth Group had a 33% rate of initial denials across 20 states, or 4,670,649 denials for Affordable Care Act patients.
The study listed reasons for denials, which included lack of prior authorization or referral, exclusion of a service, denials based on medical necessity, experimental or cosmetic procedures, administrative reasons, the enrollee's benefit reached and unspecified reasons.
The state's largest health system, UAB, has since announced it plans to drop UnitedHealthcare from its network.
UAB Health System CEO Dawn Bulgarella said the insurance giant's inability to reach a reasonable compromise has made it impossible for the system to deliver the highest quality care to patients.
UnitedHealthcare reported $14.4 billion in earnings last year, with a $6 billion profit. UAB said that profit came at the expense of policyholders and healthcare providers. The system cited below-market reimbursement rates, excessive claim denials and delayed payments as reasons it is not confident in the insurer.
"United's approach to contract negotiations has already led to breakdowns with numerous providers — and more may follow," Bulgarella said.
UnitedHealthcare told 1819 News the allegations from UAB are false. UnitedHealthcare's Alabama CEO, Bryan Palmer, stated that the claims by UAB are an attempt to divert attention from the health system's higher costs.
