California Nurses Support Bill for Transparency in Insurance Claim Denials

California Nurses Advocate for Transparency in Insurance Denial Reporting

The California Nurses Association (CNA), representing over 100,000 members across the state, has voiced its support for Assembly Bill 682. This new legislative effort, initiated by Assemblymember Liz Ortega from Hayward, aims to require public disclosure of insurance claim denials in California. The initiative seeks to highlight the often-hidden discrepancies between insurance providers and patients, which nurses argue are central to the ongoing issues in the healthcare system.

Michelle Gutierrez Vo, RN and president of CNA, emphasized the human element behind the statistics, stating, “Insurance companies see our patients as numbers on a spreadsheet, but they’re real people to us as nurses at their bedsides.” She advocated for the bill, noting, “Having publicly available information on why insurers deny claims is a major move to expose how health care is systematically denied to our patients. Nursing is about building trust with our patients; this bill will reveal how that trust is often broken by our healthcare system.”

Assemblymember Ortega highlighted the financial burden on Californians, noting, “Millions of Californians are paying high monthly premiums for their health insurance ― only to find that when they get sick and need it, their claims are denied.” Current statistics from Healthcare.gov reveal that one in five claims are denied even when patients stay in-network, and out-of-network care faces nearly a 50/50 chance of denial.

The proposed legislation would mandate detailed reporting on denied claims for all health plans under the jurisdiction of the California Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI). Reports would include the number and cost of denied claims, the use of artificial intelligence in decision-making, and specific reasons for denials, such as lack of prior authorization or out-of-network provider issues. This transparency is deemed crucial, particularly for claims related to urgent, life-saving care.

By documenting these denial practices, the bill aims to shed light on why insurance claims are withheld, revealing the strategies insurers use to avoid providing coverage. Recent media reports and daily experiences of nurses indicate that patients often remain uninformed about denial processes, which insurers have managed to keep under wraps. Nonetheless, there is significant public backing for the transparency the bill proposes.

Despite California's commendably low uninsured rate, CNA nurses support Assembly Bill 682 as a means to uncover the deliberate underinsurance strategies of healthcare plans, which leave patients without necessary care and without explanations for coverage refusals.

California Nurses Association/National Nurses United stands as the largest and fastest-growing union and professional association of registered nurses in the United States, with over 100,000 members across more than 200 facilities in California and over 225,000 RNs nationwide.