On the heals of the feds issuing new regs that’ll make it easier for employees to appeal healthcare claims denials, the New York State Insurance Department has released info that shows just how effective these appeals can be.
How many denials are likely to get reversed? Well, in New York alone, nearly 72,000 internal appeals were filed last year in which consumers tried to reverse a health insurer’s denial of coverage. And nearly half of those appeals (almost 34,000) lead to reversals — a 47% success rate.
Those stats are from the state Insurance Department’s Consumer Guide to Health Insurers.
More appeals coming?
With the new federal claims review regs set to take effect within the next year, the number of appeals filed by consumers nationwide could increase considerably.
The feds’ interim final regs guarantee individuals the right to appeal denials and coverage recessions directly to their insurers — and then, if necessary, to external review boards.
This will be the first time the external review requirement will apply to self-insured companies.
External reviews are decided by independent third-party healthcare professionals.
Last year there were 1,777 external appeals filed in New York against insurers, and 722 of them (40%) won reversals.
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