Healthcare.gov Insurance Company refuses nearly one for five claims (19 %) submitted for network services, and in 2023, more share (37 %) of over -the -net work. I refused my share.
This analysis verifies the main sources of data that has been disclosed and appeals for requests for personal market plans and appeals that can be used through the Federal Healthcare.gov Marketplace. Effective priced care methods require specific entities to report data on claims and appeals, and demand the transparency of registrant's insurance compensation. Published data does not include the market plan sold in the national -based market or employer's health plan.
In this analysis, Healthcare.gov Insurance Company had a large variation, and in some states, there was a rejection rate within a network of 54 % in 2023. Healthcare.gov as a whole, a large number of insurance companies with a high rejection rate in the network as a whole include Brucros Blue Shield in Alabama (35 % in the 12 plans in that state) and UnitedHealth Group (274 Plan in 20 States 33 %) is included. Health Care Service Corporation (29 % in the four states of 915), Molina Healthcare (26 % of the 72 plans in nine states), and Elevance Health (23 % in 154 plans in seven states).
Among the limited information that can be used for rejection in the network, the most common reason for refusal was the general reason (34 %), but a service that excluded 16 % was excluded. 9 % involved prior approval or lack of referral, 6 %. It included medical needs. Other general reasons for rejection include management issues (18 %) and benefit restrictions (12 %).
Consumers appealed in 2023 to about 1 % of the network claims. Following these appeals, insurance companies often supported their first refusal (56 %), and consumers rarely take the following steps to submit an external appeal.
This analysis will investigate 425 million claims and Medicade Service Center, submitted to 175 insurance companies selling market coverage in 2023. Additional data files including insurance companies and state -specific information are available in kff.org.
