Claims denial rates not higher in self-funded plans: HHS
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There is little evidence that self-insured health insurance plans deny claims at a higher rate than fully insured plans, the U.S. Department of Health and Human Services said in a report released Thursday.
“Overall, we find little evidence that self-insured plans differ systematically from fully-insured plans in terms of benefit generosity, price or claims denial rates, the report found.
The report noted that self-funded employers have an incentive to approve claims. Self-funded employers “may be more willing than insurance companies to cover medical costs for members, because of their greater financial stake in the health and well-being of their employees,” according to the report.
The HHS report, mandated by last year's health care reform law, also concludes that the law is unlikely to result in a significant increase in the percentage of employers self-funding their health care plans.
“It is unlikely that a large number of small businesses will opt to self-insure” once the reform law “takes full effect, unless comprehensive stop-loss coverage becomes widely available at prices that compete with fully-insured products,” according to the report.
According to the report, just more than 82% of private-sector employers with at least 500 employees self-insure at least one of their health care plans, compared with nearly 26% for employers with 100 to 499 employees and 13.5% for employers with less than 100 employees.
The report is available at aspe.hhs.gov/health/reports.
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