Health Insurers' Coverage Decisions Vary Widely, Often Reversed, GAO Says

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




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