July 6, 2022
  • A Kaiser Family Foundation analysis found that healthcare.gov marketplace insurers denied nearly one out of every five claims submitted for in-network services in 2020. Denial rates varied widely across insurers, spanning as low as 1 percent and as high as 80 percent, and by state. The Centers for Medicare & Medicaid Services (CMS) data include some information about why in-network claims are denied; however, the vast majority (72 percent) fall into a broad category of “all other reasons,” likely including administrative or paperwork errors and other issues. (Analysis here)