Study Rates WellPoint Last in Processing, Paying Claims

WellPoint Inc., the nation’s largest health insurer that covers about 1 in 10 people in the U.S., fared the worst among its peers in a survey gauging how quickly HMOs process and pay claims to doctors.

The analysis, released Thursday, examined 5 million line items in claims submitted by 7,000 doctors to health insurance companies using a computer-based payment system sold by Athenahealth Inc., which compiled the study.

Indianapolis-based WellPoint, which covers 34 million patients in the U.S., was cited as “the most aggressive shifter of responsibility to physicians to secure payment from patients directly,” the study said.

The company also fared worst in an overall composite of measures, including the likelihood of denied claims and length of time taken to pay claims.

WellPoint spokesman Jim Kappel said the study lacked “statistical significance,” noting that WellPoint processes more than 5 million charges a day, the size of the entire sample.

“I don’t know how you get accurate results with a study that small,” Kappel said, calling it a “marketing tool” for Athenahealth.

Watertown, Mass.-based Athenahealth acknowledged the shortcoming but said the study provided a valuable snapshot of health insurance payments.

Either way, doctors are likely to use the data to scrutinize HMOs, which increasingly are ranking doctor quality and cost, said Molly Katz, former president of the Ohio Medical Assn. who uses Athenahealth in her practice.

The rankings “turn the tables on payers by quantifying and reporting on how well health plans do their job,” she said.

Humana Inc., a much smaller health plan with about 9 million members, scored the best in the overall ranking. It paid claims most promptly and was least likely to deny a claim, according to the analysis. Humana beat rivals UnitedHealth Group Inc., Aetna Inc. and Cigna Corp.