KFF: Claims Denials and Appeals in #ACA Marketplace Plans in 2023
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Insurers of qualified health plans (QHPs) sold on #HealthCare.gov denied 19% of in-network #claims in 2023 and 37% of out-of-network claims for a combined average of 20% of all claims.
The in-network #denial rate ranged from 1% to 54%. There was significant variation by insurer and by state.
KFFClaims Denials and Appeals in ACA Marketplace Plans in 2023 | KFFThis brief analyzes federal transparency data released by the Centers for Medicare and Medicaid Services (CMS) on claims denials and appeals for non-group qualified health plans (QHPs) offered on HealthCare.gov in 2023. It finds that HealthCare.gov insurers denied nearly one out of every five claims (19%) submitted for in-network services. Information about the reasons for denials is limited, and few consumers appeal claims denials.
