Appeals of denials often successful

Appeals of denied insurance claims from you or your patients "frequently" are successful, according to a government review.

The Government Accountability Office (GAO) studied instances when insurers in six states, representing more than 20% of the nation's private health market, declined to write a policy and when they decided not to pay a claim. The GAO found that physician and patient appeals won reversals in 39% to 59% of cases. The report stated that many claim denials are due to incomplete information, miscoding, and other clerical errors. Claim and coverage denials varied widely from state to state. Electronic claims have a lower denial rate than paper claims, the study found.