In the new report, an individual market health plan sold on the Federal Healthcare.gov platform in 2023, by a United Health Group based on Eden Playy and two Brucros Blue Shields in 2023. I had the highest billing rate.
Overall, the market insurance company refused to pay nearly one or nearly 19 % to the five claims paid. Report from KFFCalifornia -based health policy group. Significant variation between companies is seen, and the rejection rate is from 1 % to 54 %.
Among the large insurance companies, Alabama's Brucross and Blue Shield had the highest rejection rate of 35 % of the claims in the network, followed by UnitedHealth Group. Illinois -based Healthcare Service Corp. has run a non -profit Blucross Plan in five states and has the third rejection rate at 29 %.
UNITEDHEALTH GROUP has called “severely misunderstanding” if it is applied to the entire UNITEDHEALTHCARE INSURANCE Business because it is based on a small sample that shows only 2 % of the company's total request.
“UNITEDHEALTHCARE as a whole, we will eventually pay 98 % of all claims received for qualified members.” For 2 % of the non -approved claims, the majority of services are medical and medicade services. When the benefits are established by planning sponsors such as the center.
Researchers say that it is difficult to compare companies based on the results because there is no important information in the basics collected by the federal government. According to the report, the most common reason quoted for rejection is “Others”. This reflects the results of a previous study that emphasized the problem of transparency.
“The impact of the rejection of the claim is widely recognized by the registrant,” said the report. Most of the insured has quoted a survey result indicating that he had experienced problems using a rejected claim. 39 % of the difficulties in paying medical expenses stated that the rejected claims contributed to their issues.
