Insurers denied 1,000+ claims for COVID-19 care, New Jersey hospitals say

New Jersey hospitals are seeing health insurance companies deny claims for COVID-19 testing and treatment despite regulations that require insurers to cover certain claims for COVID-19-related care, according to NJ Spotlight and survey data shared with Becker's Hospital Review.

The survey from the New Jersey Hospital Association found 30 acute care facilities reported that 1,053 claims for COVID-19 patients were denied by health insurers between March and the end of June. The hospital association said that respondents who provided dollar amounts said more than $11.8 million in claims were denied. 

Neil Eicher, vice president of government relations and policy for the association, testified to lawmakers July 9 that "the majority of claims have to do with the denials based on retrospective review for medical necessity." 

He added that despite testing precautions hospitals have taken to slow the spread of COVID-19, they're "receiving retrospective denials for services rendered because the insurance company made a determination later that the patient didn’t meet certain criteria for the testing."

The increased scrutiny of denials comes as New Jersey lawmakers consider legislation that would pause audits of insurance claims and restrict certain denials. Wardell Sanders, president and CEO of the New Jersey Association of Health Plans, told NJ Spotlight the legislation is "a bridge too far."

Representatives of New Jersey insurers said they haven't seen widespread denials for COVID-19 testing and treatment. 

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