MedCity News January 31, 2025
About one in five in-network claims were denied by insurers of qualified health plans on HealthCare.gov in 2023, according to KFF. There is also wide variation by insurer and state.
Insurers of qualified health plans on HealthCare.gov denied about one in five in-network claims and 37% of out-of-network claims in 2023, according to a new analysis from KFF.
KFF is a nonprofit health policy research, polling and news organization. The analysis looked at data from the Centers for Medicare and Medicaid services, including 425 million claims submitted to 175 insurers selling marketplace coverage in 2023.
The researchers found that the in-network denial rate ranged from 1% to 54% among HealthCare.gov issuers. There was also wide variation by state. Alabama had...
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