CMS data shows high rate of health plan claims denials
Jul 5, 2022
The Kaiser Family Foundation today released an analysis of CMS data on claims denials and appeals by health plans sold on the federal health insurance marketplace. The report found that approximately 18% of in-network claims were denied on average during the reporting period but some plans reached as high as 80%. According to KFF, “Consumers rarely appeal denied claims and when they do, insurers usually uphold their original decision.” The Affordable Care Act requires reporting of these data as part of federal marketplace plan transparency, but such provisions are only partially implemented.