Patient and Consumer Protections
Claims Denials and Appeals in ACA Marketplace Plans in 2021
This analysis of HealthCare.gov Marketplace insurers’ transparency data finds that 17% of in-network claims were denied in 2021, with denial rates varying widely across insurers. Consumers appealed less than two-tenths of 1% of denied in-network claims.
-
Examining Prior Authorization in Health Insurance
This post explains what’s known about how insurers use prior authorization as a tool to control costs and encourage cost-effective care, the state and federal laws that govern it, and ongoing policy debates over efforts to impose standards to limit or regulate its use.
-
CMS Prior Authorization Proposal Aims to Streamline the Process and Improve Transparency
This brief explains a new proposed federal regulation aimed at reducing administrative hassles involved in obtaining prior authorization for care and sets out key policy questions, including how the proposal could impact the patient experience and data privacy.
-
Over 35 Million Prior Authorization Requests Were Submitted to Medicare Advantage Plans in 2021
We analyze data from CMS to examine the number and outcome of Medicare Advantage prior authorization requests in 2021, overall and by firm.
Surprise Medical Bills: New Protections for Consumers Take Effect
This summarizes key provisions of the No Surprises Act, enacted in December 2020 to address the problem of unexpected medical bills, and issues that could arise during implementation ahead of its Jan. 1, 2022 effective date.
