Healthcare DIVE January 31, 2025
Insurers said the data is misleading and includes a number of claims that weren’t eligible to be paid.
Insurers that sell Affordable Care Act plans on the federal exchange denied nearly one out of every five claims for services that should have been covered in 2023, according to new research from health policy firm KFF.
Out-of-network services were denied at an even higher rate, with more than one-third of claims refused that year.
Insurers offering plans on HealthCare.gov had huge variation in their denial rates. But nationwide, the insurers with the highest volume of in-network denials were Blue Cross Blue Shield of Alabama with 35% of claims denied; UnitedHealth with 33%; Health Care Service Corporation with 29%; Molina with 26%...
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