CMS data shows high rate of health plan claims denials

The Kaiser Family Foundation today released an analysis of CMS data on claims denials and appeals by health plans sold on the federal health insurance marketplace. The report found that approximately 18% of in-network claims were denied on average during the reporting period but some plans reached as high as 80%. According to KFF, “Consumers rarely appeal denied claims and when they do, insurers usually uphold their original decision.” The Affordable Care Act requires reporting of these data as part of federal marketplace plan transparency, but such provisions are only partially implemented.
Related News Articles
Headline
The Congressional Budget Office today released its estimate of the budgetary effects of the One Big Beautiful Bill Act, as enacted. CBO projects the law will…
Headline
Health Insurance Marketplace insurers will propose a median premium increase of 15% for 2026, according to an analysis of preliminary rate filings published…
Headline
The AHA July 3 released the Health Care Plan Accountability Update for the second quarter of 2025. The update covers the latest developments in Medicare…
Headline
The Department of Health and Human Services June 23 announced an initiative coordinated with multiple health insurance companies to streamline prior…
Headline
The departments of Health and Human Services, Labor, and the Treasury have certified two more independent dispute resolution entities, bringing the total…
Headline
The Centers for Medicare & Medicaid Services April 10 announced that it does not intend to approve new or extend existing requests for federal funds to…