Health insurance claim denials disproportionately affect low-income patients and historically marginalized groups, according to recent research conducted by the University of Massachusetts Amherst. The study found that individuals with household incomes below $50,000 are less likely to challenge denials of their health insurance claims compared to those with higher incomes. Even when these denials are contested, the outcomes are often less successful for low-income patients.
Published in the journal Health Affairs, the study highlights the disparities in health insurance coverage across demographic and socioeconomic dimensions. Previous research by the same team revealed that low-income patients were 43% more likely to have their claims denied for preventive care services such as cancer screenings, cholesterol checks, and wellness visits. Additionally, historically marginalized racial and ethnic groups were at a higher risk of claim denials compared to non-Hispanic whites.
The latest findings shed light on the fact that low-income individuals and marginalized groups are less likely to contest denied claims. However, when they do challenge these denials, they are more likely to be successful compared to non-Hispanic whites. Despite this, the reduction in cost-sharing for Black and Hispanic individuals is lower than that of their white counterparts.
The study also found that education level did not impact the likelihood of contesting denied claims or the success rate of these challenges. Researchers analyzed data from over 50,000 denied claims of medical services provided to U.S. adults with private health insurance between 2017 and 2019. They discovered that a significant portion of these denials stemmed from billing errors and processing mistakes by healthcare providers and insurers.
The research underscores the need for policy changes to address the systemic inequities in health insurance coverage. Lead researcher Michal Horný suggests implementing user-friendly processes for contesting denials, such as online forms accessible 24/7. He also recommends universal billing codes among payers to simplify the claims process and reduce errors.
In conclusion, the study highlights the financial burdens faced by low-income patients and historically marginalized groups due to health insurance claim denials. By addressing these disparities and implementing practical solutions, we can work towards a more equitable healthcare system for all individuals, regardless of income or background.
