HHS defends denial metrics on insurance Web portal

New data posted Friday on the government's health insurance Web portal offer consumers a "pretty good measure" of their chances of being denied coverage, the deputy director of HHS's Office of Consumer Support said.

"It's not perfect," said Karen Pollitz, "but it gives you a pretty good idea about what to expect in the marketplace today."

The comments come as America's Health Insurance Plans raises questions about the denial rates that come up on Healthcare.gov when consumers search for insurance in their ZIP code. HHS added pricing information to the website on Friday, along with information gathered from insurers about the percentage of people who applied for insurance and were denied coverage and the percentage of applicants who were charged higher premiums because of their health status.

"Healthcare.gov makes the insurance marketplace more open and more transparent than ever before," said Todd Park, chief technology officer at HHS. "And a more transparent marketplace is one where there's more competition between insurance companies for consumers' business; more competition means lower costs and better value for consumers."

AHIP Spokesman Robert Zirkelbach said the denials include people turned down because they applied for plans in the wrong state or who were eventually sold a different plan than the one they first applied for.

That's still a denial, Pollitz argued.

"Sometimes," she said, "an insurer will say, 'Well, based on what you've told me about your health policy, I'm not going to sell you this policy; I refuse to sell you this policy that you asked for — but I'd offer you this other policy,' " she said. "Maybe it has a higher deductible, maybe it doesn't include a drug benefit ... It has sufficiently less coverage that it kind of cures the insurer from having to worry about being exposed to paying for whatever health needs it is that you've disclosed."

She added that the denials don't include people who were persuaded not to apply in the first place because of their pre-existing conditions, a practice sometimes referred to as "street underwriting."

Pollitz added that the private insurance rates quoted on the portal were for healthy people; those with pre-existing conditions can expect to pay higher premiums or have further restrictions on their coverage.

"We don't put you through medical underwriting on this site," she said.