Health insurers' decisions on applications and claims vary widely and are frequently reversed on appeal, according to a report by the Government Accountability Office.
GAO made the following findings.
Application denials varied widely. While the aggregate rate was 19 percent, about one quarter of insurers had rates from 0-15 percent while another quarter had rates of 40 percent or more.
Denials for preauthorizations and claims also varied. Aggregate rates in three states ranged from 11-24 percent and rates across insurers 6-40 percent in one state.
Appeals were frequently reversed. In four states, 39-59 percent of appeals resulted in the reversal of an original coverage denial. And appeals in an independent, external review brought about a reversal about 40 percent of the time.
Read the GAO report on health insurers.
Read more coverage of denials of insurance coverage:
- Illinois Blue Cross Blue Shield Will Pay $25M to Settle Allegations of Denying Children Coverage, Shifting Costs to Medicaid
GAO made the following findings.
Application denials varied widely. While the aggregate rate was 19 percent, about one quarter of insurers had rates from 0-15 percent while another quarter had rates of 40 percent or more.
Denials for preauthorizations and claims also varied. Aggregate rates in three states ranged from 11-24 percent and rates across insurers 6-40 percent in one state.
Appeals were frequently reversed. In four states, 39-59 percent of appeals resulted in the reversal of an original coverage denial. And appeals in an independent, external review brought about a reversal about 40 percent of the time.
Read the GAO report on health insurers.
Read more coverage of denials of insurance coverage:
- Illinois Blue Cross Blue Shield Will Pay $25M to Settle Allegations of Denying Children Coverage, Shifting Costs to Medicaid