Rating Health Insurers' Efficiency

Special Feature

Slow pay and no pay. Those are two of the most common complaints that doctors have about insurance carriers. They take too long to pay, they bounce too many claims back to be resubmitted, and they deny claims that doctors think should be paid. But some health insurers do a better job than others.

Slow pay and no pay. Those are two of the most common complaints that doctors have about insurance carriers. They take too long to pay, they bounce too many claims back to be resubmitted, and they deny claims that doctors think should be paid. But some health insurers do a better job than others.

Athenahealth, which provides medical practice-management services to about 13,000 clients, has surveyed its customer base for the past 3 years on insurance company efficiency. In the latest survey, Aetna came out a clear winner, with Cigna taking second place. Athenahealth used seven criteria in its ranking, giving extra weight to the average number of days the company took to pay doctors, the percentage of claims paid on the first pass, and the percentage of claims denied.

Aetna did well in all three categories, taking an average of 27 days to pay claims, paying 96% of claims on the first submission, and denying 5.9% of claims. Aetna’s performance has shown improvement every year since the survey started, a fact that the company says is due to efforts to improve claims processing efficiency and working with doctors to clarify company policies.

Lowest in the Athenahealth survey was New York’s Medicaid program, which took an average of 137 days to pay claims, resolved just 57% of claims on the first try, and denied almost 40% of claims. According to a spokesperson for New York’s Department of Health, however, the program’s claim denial rate is actually 24%, which is still far above that of Aetna and Cigna.