Eine neue CMS-basierte Analyse zeigt, dass die Ablehnungsraten von ACA-Anträgen variieren 5 % bis 27 % im ganzen Land, mit erheblichen Unterschieden je nach Versicherer, Staat und Marktstruktur.
Quellen: CMS Transparency in Coverage Public Use Files (Planjahr 2024), CMS QHP Landscape File, CMS Medical Loss Ratio-Einreichungen, von Versicherern gemeldete Ablehnungsdaten und KFF-Umfragedaten; MoneyGeek-Analyse.
Vollständige Datentabellen und Aufschlüsselung nach Bundesstaat/Versicherer:
moneygeek.com/insurance/health/aca-claim-denial-rates-by-state-and-insurer/
Von mark-fitzbuzztrick
2 Kommentare
The website didn’t bother checking their tables. It can’t sort rates properly. It’s sorting it like strings and not as a number (probably because of the % at the end).
For anyone interested, in 2024, Hawaii has the worst deny rate (~27%), South Dakota has the best (~5%).
Two huge points from this, assuming the data and its analysis are legitimate:
> “Three in four denials (77%) stem from paperwork or plan design, not medical judgment.”
> “Consumers rarely appeal: fewer than 0.2% of denied claims were appealed internally, and 56% of those appeals were upheld.”