Private Health Insurance: Data on Applications and Coverage Denials
DIANE Publishing, 2011 - 42 pages
The large percentage of Americans that rely on private health insurance for health care coverage could expand with enactment of the Patient Protection and Affordable Care Act (PPACA) of 2010. Until PPACA is fully implemented, some consumers seeking coverage can have their applications for enrollment denied, and those enrolled may face denials of coverage for specific medical services. PPACA required this study of the rates of such application and coverage denials. The study reviewed the data available on denials of: (1) applications for enrollment; and (2) coverage for medical services. Charts and tables. This is a print on demand edition of an important, hard-to-find publication.
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AHIP data appeals related application and coverage application denial rates application or coverage applications for enrollment calendar California claim denial rates complaints related Connecticut coverage for medical data available data indicated data on application data reported data we reviewed denials of applications denials of coverage employer ERISA example external appeals External Review federal frequently reversed GAO’s Review Gresenz group coverage group health plans health coverage health insurance issuers Health Maintenance Organizations HIPAA HMOs incidence of application included data Independent Medical Review indicated that coverage individual coverage individual market insurance issuers offering insurer’s insurers licensed insurers operating Kaiser Family Foundation managed care organizations Maryland Insurance Administration’s medical services medically necessary NAIC offer coverage Ohio outcomes of appeals outcomes of external percent plan years beginning preauthorization denials preferred provider organization private health insurance rates across insurers reasons for denials related to coverage reviewed data Structured Literature Review U.S. Census Bureau