Appeals of denials often successful

June 10, 2011

Appeals of denied insurance claims from you our your patients "frequently" are successful.

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 in six states, representing more than 20% of the nation's private health market, declined to write a policy and when they decided not to pay a claim. The GAO found that physician and patient appeals won reversals in 39% to 59% of cases. The report stated 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.