Patients underutilize appeals of insurance denials

Only about 0.2 percent of medical insurance denials are appealed by consumers, according to a March 28 Medscape Medical News article.  

The low percentage of appeals comes despite the fact that about 50 percent of appeals are successful, according to the article. 

Rules put into effect in 2010 by the Affordable Care Act aimed at making the appeals process easier. Many people don't realize they have the right to appeal, however,  Monica Fawzy Bryant, a lawyer with patient-support organization Triage Cancer, told Medscape Medical News. 

Ms. Fawzy Byrant said what the law requires in the appeals process is relatively simple. The complexity stems from showing the medical necessity, and that needs to be done by the healthcare team. 

Medical professionals are overworked, inundated with all they have to do, so the additional burden of appealing is on healthcare providers as well as the patients, Ms. Fawzy Bryant said. 

Healthcare software company Change Healthcare estimated that U.S. hospitals spend up to $8.6 billion annually in administrative costs to appeal denied claims, according to the article. 

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