Health plan members are winning more appeals in Massachusetts

A significant number of health insurance consumers gained coverage for services after filing an appeal, according to research from the Massachusetts Health Policy Commission.

The research, which examines trends in internal appeals and external reviews filed by health plan members in Massachusetts from 2014 to 2017, found more consumers are winning appeals overall.

The number of internal appeals has increased each year since 2014, with more consumers receiving a favorable outcome: 57 percent of health plan members won internal appeals in 2017, up from 44 percent in 2014.

The HPC also found while appeals increased overall, behavioral health appeals decreased in the same time period. This could suggest policy changes aimed at creating greater access to behavioral healthcare are working, the researchers said.

Still, HPC found consumers who filed internal appeals to health insurers for medical or surgical treatment won their appeals twice as much as consumers who appealed coverage decisions related to behavioral health treatment.

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