Despite state laws aimed at ensuring affordable health care, a new report from the Commonwealth Fund reveals many patients face unexpected medical bills and insurance denials without taking action.
Released Thursday, the report shows less than half of those affected by insurance denials or billing issues challenged these decisions. The primary reason cited was unawareness of their right to do so.
Sara Collins from the Commonwealth Fund emphasized the need for better consumer education on insurance rights. The report highlighted that younger individuals with moderate incomes were less likely to challenge bills or denials due to lack of awareness.
The study also noted disparities by race and ethnicity. Hispanic residents were more likely than Black or white residents to be unaware of their rights in challenging insurance decisions.
States like Pennsylvania have introduced initiatives to support patients facing coverage denials. Pennsylvania’s Independent Review Program, launched in January, has reviewed 194 cases in its first six months. Over half of these reviews resulted in overturned denials and approved coverage.
Similarly, Delaware and New Jersey offer arbitration programs for residents facing insurance challenges. However, the survey found that one in four individuals did not pursue appeals due to uncertainty about whom to contact.
The Commonwealth Fund’s survey, based on responses from 5,602 insured individuals, highlighted significant impacts from insurance denials. Nearly 60% reported delayed care, and nearly half experienced worsened health conditions as a result.
Recommendations from the report include strengthening monitoring of insurance denials and imposing stricter penalties for wrongful denials. Collins stressed the importance of public awareness about health care rights and accessible resources for filing appeals.
“Increasing transparency by including contact information on denial notices would empower consumers,” Collins suggested.
