Claim Denials: Low-Income Patients From Disadvantaged Racial And Ethnic Groups Experienced The Largest Burdens.

Abstract

Insurance claim denials are a common source of administrative burden, especially for patients with private health insurance. Contesting denied claims requires considerable investment from physicians and patients or caregivers, including both institutional knowledge of health policies and billing practices and the means to engage in reconciliation. We used a novel national data set comprising remittance data and patient demographics to describe disparities in the rates of seeking and receiving claim denial corrections across demographic and socioeconomic dimensions. We found that patients from historically disadvantaged racial and ethnic groups or with low household incomes experienced the largest burdens from claim denials. Patients with household incomes less than $50,000 annually were least likely to have denied claims contested and, conditionally, have cost-sharing obligations reduced. Racial minority patients were more likely than non-Hispanic White patients to have cost-sharing obligations reduced but achieved lower mean savings per successfully contested denial. Policy makers working to promote equitable health care access should make available more resources for contesting and rectifying administrative errors and enact policies to prevent billing errors and consequent claim denials.