A recent study by the esteemed Kaiser Family Foundation showed that insurance carriers denied an alarming average of 17% of all medical claims filed in 2021. One insurer showed a denial rate of 49% in 2021, another a whopping 80% in 2020.
Automated claim processing is cited as an increasingly significant reason for such denials. Automated processing leads to automated rejections, without consideration of any medical necessity, chart notes, doctor letters or even the application of common sense.
There are other reasons, but the Department of Health Services, tasked under the Affordable Care Act with a comprehensive study of causes and potential corrections, has yet to show any substantial or consistent findings.
While the study and statistics are alarming enough, the lack of action – by anyone – is disturbing. Worse, the Kaiser Foundation shows that only 1 in 500 ever file an appeal. This is something the carriers count on. Our company believes a new approach is needed.
Medical Appeal Experts knows that human error (by patients and providers), the “need for speed” and a lack of sufficient training of claim examiners all contribute to the problem. So what is the solution?
That’s why we formed Medical Appeal Experts, a group of experienced professionals in dealing with medical issues and the claims complexity that follows with regard to insurance payment.
With denials on the rise and an increasing appetite among insurance companies to find reasons to issue them, we provide educational materials on insurance processes, partnering with your provider on sending complete claims and, when necessary, guiding patients through the claim appeals process. Our services include medical and insurance coverage advocacy so that those that need help the most get it in an efficient and expeditious manner.
Original Article by Elisabeth Rosenthal:
https://www.washingtonpost.com/opinions/2023/05/17/health-insurance-denial-claims-reasons/
