In the report, published Feb. 9, researchers analyzed transparency data for exchange plans offered on healthcare.gov.
The most common listed reason claims were denied was the claim was for an excluded service. Of the 44.7 million in-network claim denials posted in 2021, 76.5 percent were for other reasons.
Here’s what the data showed about the most common claim denials:
Lack of prior authorization: 3.6 million, 8 percent
Excluded service: 6 million, 13.5 percent
Medical necessity (behavioral health): 150,000, 0.3 percent
Medical necessity (all other): 770,000, 1.7 percent
Other: 34.2 million, 76.5 percent
