Appeals of claims denials surprisingly successful

May 11, 2011

Appeals of denied insurance claims from you or your patients ?frequently? are successful, according to a government review.

 

Appeals of denied insurance claims from you or your patients “frequently” are successful, according to a government review.

The Government Accountability Office (GAO) studied instances when insurers declined to write a policy and when they decided not to pay a claim and found that physician and patient appeals won reversals in 39% to 59% of cases.

The GAO report found that many claim denials are due to incomplete information, miscoding, and other clerical errors. Claim and coverage denials varied widely from state to state. Electronic claims have a lower denial rate than paper claims, the study found.

See the study here.