Why few denied health insurance claims are appealed
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Every year, health insurers deny around 850 million claims, but fewer than 1% are appealed, often due to the process's complexity, which involves lengthy phone calls and gathering detailed medical evidence. This low appeal rate suggests that many people may not understand how to navigate the system or find the process too daunting. Moreover, insurers are increasingly using artificial intelligence to streamline claims processing, but this technology has faced criticism and legal challenges, with claims that it may inadvertently increase denial rates. Despite these challenges, those who appeal have a considerable chance of success, highlighting the value of understanding and engaging with the appeals process to secure proper health benefits.
Source
Hoagland A, Yu O, Horný M. Social Determinants of Health and Insurance Claim Denials for Preventive Care. JAMA Netw Open. 2024 Sep 3;7(9):e2433316. doi: 10.1001/jamanetworkopen.2024.33316. PMID: 39292461; PMCID: PMC11411384.
Additional Reading
https://www.wsj.com/health/healthcare/health-insurance-denials-fight-back-70a1328e