Healthcare DIVE July 6, 2022
Dive Brief:
- Affordable Care Act marketplace insurers denied on average roughly 18% of in-network claims in 2020, according to a new report from the Kaiser Family Foundation.
- Of 230.9 million in-network claims reported, 42.3 million claims were denied for reasons including lacking prior authorization, excluded services and medical necessity. One in five medical necessity denials were for behavioral health services.
- However, five years into ACA-mandated transparency for coverage data, reporting for 2020 remained spotty, showing limited insight into coverage denials and potentially limiting insurer transparency and consumer protection enforcement, KFF said.
Dive Insight:
The ACA requires participating plans to provide data for claims, enrollment, cost-sharing and out of network payments.
However, more than a decade after implementation of...
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