Few Health Insurance Claim Denial Appeals Approved in Arizona
Since 2003, Arizona has approved less than one in five appeals from consumers whose insurance companies refused to pay for a claim or approve a medical procedure, the AP/Arizona Daily Star reports. Arizona, which examines dozens of cases annually, is one of 44 states that provides independent review of health insurance coverage disputes, according to the AP/Daily Star.
The state Department of Insurance said appeal reviewers read insurance policies, check medical records and research laws to determine each case. According to the AP/Daily Star, officials contend low percentage of approvals are in large part because the cases are "long-shot challenges that don't jibe with the terms spelled out in insurers' contracts." Mary Butterfield, the department's assistant director of consumer affairs, said, "We can't overturn and make [insurers] pay for something that is excluded," adding, "Many times people continue through the review process even though it is clearly excluded." Critics contend that the appeals program offers little protection for consumers, the AP/Daily Star reports
A recent study by America's Health Insurance Plans found that state-administered appeals programs upheld the health insurer's decision in 59% of the cases in 2006 (AP/Arizona Daily Star, 11/04).
