Claims Denials and Appeals in ACA Marketplace Plans in 2020

(By Karen Pollitz, Matthew Rae, and Salem Mengistu for Kaiser Family Foundation published July 5, 2022)

In this report, we analyze transparency data released by the Centers for Medicare and Medicaid Services (CMS) on claims denials and appeals for non-group qualified health plans (QHPs) offered on HealthCare.gov. Data were reported by insurers for the 2020 plan year, posted in a public use file in 2021, and updated in 2022. We find that, across HealthCare.gov insurers with complete data, about 18% of in-network claims were denied in 2020. Insurer denial rates varied widely around this average, ranging from less than 1% to more than 80%. Continue reading here…

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