Forbes March 28, 2024
When an individual files a medical insurance claim, they expect swift processing, approval, and treatment from the stakeholders involved. According to a recent KFF study of Affordable Care Act (ACA) plans, even when patients received care from in-network physicians, the insurers denied 17% of claims in 2021. One insurer denied 49% of claims in the same period, while another’s denials touched an astonishing 80% in 2020. The root cause of these turndowns appears to be the manual approach to handling claims. The stakeholders just have so much on their plates that they are making errors leading to denials, finding it difficult to process the claims on time, and even engaging in time-consuming reworks impacting the bottom line.
While the problem...
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