HJAR Nov/Dec 2023

HEALTHCARE JOURNAL OF ARKANSAS I  NOV / DEC 2023 33 transparency push didn’t. The agency with- drew its proposal in September 2019. A Labor Department spokesperson said the Biden administration has no immediate plan to revive it. Ultimately, it’s the National Association of Insurance Commissioners, a group for the top elected or appointed state insur- ance regulators, that has assembled the most robust details about insurance denials. The association’s data encompasses more plans than the federal information, is more consistent and captures more specifics, including numbers of out-of-network deni- als, information about prior authorizations and denial rates for pharmacy claims. All states except New York and North Dakota participate. Yet, consumers get almost no access. The commissioners’ association only publishes national aggregate statistics, keeping the rest of its cache secret. When ProPublica requested the detailed data from each state’s insurance depart- ment, none would hand it over. More than 30 states said insurers had submitted the information under the authority commis- sioners are granted to examine insurers’ conduct. And under their states’codes, they said, examination materials must be kept confidential. The commissioners association said state insurance regulators use the information to compare companies, flag outliers and track trends. Birny Birnbaum, a longtime insurance watchdog who serves on the group’s panel of consumer representatives, said the asso- ciation’s approach reflects how state insur- ance regulators have been captured by the insurance industry’s demands for secrecy. “Many seem to view their roles as protec- tors of industry information, as opposed to enforcers of public information laws,”Birn- baum said in an email. Connecticut and Vermont compile their own figures and make them publicly acces- sible. Connecticut began reporting informa- tion on denials first, adding these numbers to its annual insurer report card in 2011. Vermont demands more details, requiring insurers that cover more than 2,000 Ver- monters to publicly release prior authoriza- tion and prescription drug information that is similar to what the state insurance com- missioners collect. Perhaps most usefully, insurers have to separate claims denied because of administrative problems —many of which will be resubmitted and paid — from denials that have “member impact.” These involve services rejected on medical grounds or because they are contractually excluded. Mike Fisher, Vermont’s state health care advocate, said there’s little indication con- sumers or employers are using the state’s information, but he still thinks the prospect of public scrutiny may have affected insur- ers’ practices. The most recent data shows Vermont plans had denial rates between 7.7% and 10.26%, considerably lower than the average for plans on Healthcare.gov. “I suspect that’s not a coincidence,”Fisher said. “Shining a light on things helps.” Despite persistent complaints from insur- ers that Vermont’s requirements are time- consuming and expensive, no insurers have left the state over it. “Certainly not,” said SebastianArduengo, who oversees the reporting for the Vermont Department of Financial Regulation. In California, once considered the most transparent state, the Department of Man- aged Health Care in 2011 stopped requir- ing insurance carriers to specify howmany claims they rejected. A department spokesperson said in an email that the agency follows the require- ments in state law, and the law doesn’t require health plans to disclose denials. The state posts reports that flag some plans for failing to pay claims fairly and on time. Consumers can use those to calculate bare-bones denial rates for some insurers, but for others, you’d have to file a public records request to get the details needed to do the math. Despite the struggles of the last 15 years, Pollitz hasn’t given up hope that one day there will be enough public information to rank insurers by their denial rates and compare how reliably they provide different services, from behavioral health to emer- gency care. “There’s a name and shame function that is possible here,” she said. “It holds some real potential for getting plans to clean up their acts.” n Kirsten Berg contributed research. David Arm- strong and Patrick Rucker contributed reporting. “In recent years, doctors and patients have complained bitterly that insurers are requiring them to get approval in advance for an increasing array of services, causing delays and, in some instances, harm.”