Health insurers selling plans on HealthCare.gov denied 17 percent of in-network claims on average during the 2016 plan year, according a Kaiser Family Foundation analysis.
Across insurers, denial rates ranged from less than 1 percent to more than 65 percent. Molina Healthcare reported denying 32 percent of in-network claims submitted in 2017, up from 22 percent in 2015. Blue Cross Blue Shield of South Carolina reported denying 30 percent of claims in 2017, up from 15 percent in 2015.
UPMC Health Plan had one of the lowest denial rates at 4 percent in 2015, 2016 and 2017. In addition, Security Health Plan of Wisconsin denied 7 percent of in-network claims in 2017, down from 35 percent in 2015.
For the analysis, researchers examined ACA transparency data from CMS to look at nearly 230 million claims submitted to 130 insurers offering individual market coverage through HealthCare.gov in 2017. The analysis also found that enrollees don’t often appeal claims denials.
Date: March 5, 2019