Summary of Main Findings

  • Private health plans offering more coverage in terms of prescription drugs, mental health treatment, private hospital rooms, vision care etc. are perceived to be of higher quality
  • Refusal to pay an insurance claim as expected reduces satisfaction with the plan, especially among people who had utilized hospital care
  • African Americans and Hispanic Americans are more likely to have used a lot of hospital care and experienced claims refusal
  • Racial gap persisted even after controlling for income and education

This paper started out as a broad exploration of factors driving consumer satisfaction with their private health insurance plans, using data from a landline-cellphone bilingual (English/Spanish) telephone survey conducted in November 2009 with a nationally-representative probability sample of 1,502 adults. The survey was co-sponsored by the Associated Press, Stanford University, and the Robert Wood Johnson Foundation.

Below is a chart showing the distribution of health insurance coverage nationwide at the time of this research. Focus of this paper was mainly on private insurance plans.

insurance coverage pie.jpg

Survey estimates revealed that most Americans are happy with their health plans - 72% of adults rated the quality of their private plans as "good" or "excellent". Nevertheless, there is a notable minority giving lower ratings. Our goal was to account for this variation in plan satisfaction based on available data.

health plan satisfaction.jpg

As expected, private plans offering more coverage, such as coverage of prescription drugs, mental health treatment, private hospital rooms, vision care etc. received higher ratings. And beneficiaries who had gotten more health care tend to give slightly higher ratings on their health plans. 

health plan attributes predicting satisfaction.jpg

On the other hand, refusal to pay an insurance claim dramatically reduced health plan satisfaction. Such claims refusal was especially damaging on customer satisfaction among patients who had visited hospitals multiple times in the past 5 years. 

main effect of claims refusal.jpg

interaction effect of claims refusal.jpg

This interaction effect of refusal x amount of care persisted after controlling for quality of health; negating the potential explanation that it is sicker patients who are generally negative about everything.

So who are the people who are most likely to use a lot of hospital care AND were refused payment? We found:

  • No gender difference
  • No age difference
  • No education difference
  • No income difference
  • Race was only differential – Black and Hispanic Americans significantly more likely than other racial groups to have used a lot of hospital care AND experienced claims refusal. These race effects remained robust after controlling for other socio-economic factors such as income and education.

Summary of Main Findings

  •  Private health plans offering more coverage in terms of prescription drugs, mental health treatment, private hospital rooms, vision care etc. are perceived to be of higher quality
  • Refusal to pay an insurance claim as expected reduces satisfaction with the plan, especially among people who had utilized hospital care
  • African Americans and Hispanic Americans are more likely to have used a lot of hospital care and experienced claims refusal
  • Robust race effects persisted even after controlling for income and education


Citation: Chang, LinChiat, Jon Krosnick, Trevor Tompson. 2011. The Impact of Claims Refusal on Satisfaction with Health Insurance Plans. Paper presented at the annual meeting of the American Association for Public Opinion Research.