Letters to the Editor: Insurance companies should be required to be transparent about denial rates

To the editor: Guest contributor Neal K. Shah is correct that excessive denials of medical insurance coverage are a serious problem (“Open enrollment is healthcare’s most expensive lie,” Oct. 27). But I believe that he’s wrong about what’s primarily to blame.

Shah says the problem is the open enrollment process under the Affordable Care Act — and implies that it was all hunky-dory when many of us got our health insurance from employer-provided plans that were selected for us.

As I see it, the real problem is simply that insurance companies aren’t required to be transparent about their denial rates, an issue that Shah does highlight. A bill that would have remedied this in California, Senate Bill 363, introduced by Sen. Scott Wiener, stalled in the state Legislature this year. This bill would have required insurance companies to publicly report any denials or modifications made to provider-recommended care. It also would have fined them for excessive rates of coverage denials later overturned on appeal.

This bill would have discouraged excessive denials in the first place. And the annual publication of this information would have given consumers the information they need to make an informed choice between plans.

Currently, nearly 72% of health plan denials that are appealed to the Department of Insurance are overturned. These reversals represent medically necessary care that was wrongly denied. Worse yet, health plans currently face no consequences for denying care that was recommended by their provider. This is what needs to change.

Isabel Storey, Santa Monica