An analysis from a health policy research organization (KFF) found that major medical insurers offering plans to individuals via the Healthcare.gov marketplace rejected nearly 1 in 5 in-network claims in 2021. While this suggests that average denial rates are close to 20%, rates varied drastically among plan issuers, ranging from 2% to 49%. A separate KFF survey also found that people with private insurance are more likely to have denied claims than those with public coverage. Overall, 18% of insured adults said they had experienced a claim denial in the past 12 months, according to the survey.

Another survey in 2023 from The Commonwealth Fund found that 45% of working-age adults with insurance reported they or a family member received a medical bill or a copayment charge for a service respondents thought should have been free or covered by insurance in the past year. It also found that 17% of respondents said an insurer had denied coverage of care for them or a family member that was recommended by a doctor, with more than half saying neither they nor their doctor challenged the denial.

According to federal data, only 35% of providers appeal denials when 90% are preventable. More importantly, 66% are recoverable! As a result, C+ Consulting is pleased to offer Appeal Services which include the following assistance:

• Response to payor’s denial letter and request for additional documentation (ADR), which may include the initiation of the first level of appeal. This may also include a "rebuttal" letter if the denials are a result of an audit by an outside contractor, such as a Recovery Audit Contractor (RAC) or Unified Program Integrity Contractor (UPIC).
• Documentation packet preparation for each patient account and date of service (DOS), to include documentation which addresses each denial reason listed by the audit contractor, if given.
• Cover letters for each patient’s account and DOS outlining denial reasons and documentation present in the response packets to counter the denial rationale. These letters would be used for both the rebuttal, if approved, or for the appeal process, if rebuttal is denied.
• Final review of documentation packets prior to their submission, which may or may not include travel to the Company’s place of business.
• Appeal actions for any accounts that require one (1) or more of the first four (4) Medicare appeal levels, which may or may not include additional documentation submission.
• Follow-up provided will include any telephonic or electronic responses related to the rebuttal or appeal process, until such efforts are ceased by the client.