Question 15 of 15
A denial letter feels final. Every plan is required to offer a way to challenge it, and the letter itself explains how.
Among plans sold on HealthCare.gov, about what share of denied in-network claims do patients appeal?
Correct. Not quite. KFF’s analyses of the data insurers report to the federal government have found, year after year, that patients appeal fewer than 1 percent of denied in-network claims on HealthCare.gov plans. Of the appeals that are filed, a substantial share are decided in the patient’s favor. You have the right to an internal appeal and, for most plans, a review by an independent outside organization. The denial notice gives the deadline. Many denials come from missing information that the provider’s office can supply.
More: Got a Denied Insurance Claim? Stop! Don’t Pay That Bill Yet