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Ask KFF: Karen Pollitz Answers 3 Questions on Why Insurers Deny Claims

Karen Pollitz, senior fellow for health reform and private insurance at KFF, answers three questions about denied claims and how the federal government may change the data insurers are required to report on this issue.

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The Henry J. Kaiser Family Foundation

Private Insurance

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The Henry J. Kaiser Family Foundation

Analysis: Marketplace Plans Denied an Average of Nearly One in Five Claims in 2017 with Wide Variations across Insurers

Healthcare.gov marketplace insurers denied nearly one out of every five claims (19%) submitted for in-network services in 2017, and enrollees only appeal a tiny share (0.5%) of those denied claims, a KFF analysis of recently released claims data finds. The analysis finds a huge variation across insurers, with average denial…

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Claims Denials and Appeals in ACA Marketplace Plans

Based on an analysis of transparency data released by the Centers for Medicare and Medicaid Services (CMS), this brief assess claims denials and appeals among issuers offering individual market coverage on healthcare.gov and finds that 19% of in-network claims were denied by issuers in 2017, with denial rates for specific issuers varying significantly around this average, from less than 1% to more than 40%. Consumers appealed less than 1% of denied claims.

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The Henry J. Kaiser Family Foundation

Long-Term Trends in Employer-Based Coverage

A new issue brief looks at long-term trends in employer-based health insurance coverage, and finds that although the share of nonelderly Americans with employer-based health insurance has risen modestly in recent years, the long-term trend still shows a decline.  If coverage rates had stayed at the 1999 level (67.3%), almost 24…

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The Henry J. Kaiser Family Foundation

The Quiet, Steady Rise of Employer Health Coverage

This Drew Altman column in Axios reveals an uptick in the number of Americans with employer coverage, and discusses the implications for policy and politics. 

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The Henry J. Kaiser Family Foundation

Testimony: Pre-Existing Conditions and Health Insurance

KFF’s Karen Pollitz testimony before the U.S. House Committee on Ways and Means on Jan. 29, 2019 examines the prevalence of pre-existing conditions, the impact of the Affordable Care Act’s prohibition against medical underwriting and other provisions aimed at stabilizing the insurance risk pool, and the trade-offs involved in relaxing those provisions. 

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Policies on Abortion Coverage in Medicaid and Private Insurance: Post-ACA, 2019

Interactive: How State Policies Shape Access to Abortion Coverage

This interactive map shows the increase in states with laws limiting abortion coverage in Medicaid and private insurance for the years 2000, 2010, and 2019, before and after the passage of the Affordable Care Act (ACA).

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Women’s Health Insurance Coverage

This factsheet reviews major sources of coverage for women residing in the U.S. in 2017, discusses the impact of the ACA on women’s coverage, and the coverage challenges that many women continue to face.

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