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

Area of Science:

• Health Services Research
• Health Economics
• Health Equity

Background:

• Insurance claim denials represent a significant administrative hurdle for patients, particularly those with private health insurance.
• Contesting denials demands substantial resources, including knowledge of health policies and billing, and the capacity for dispute resolution.

Purpose of the Study:

• To analyze disparities in the process of seeking and obtaining corrections for insurance claim denials.
• To examine these disparities across various demographic and socioeconomic factors using a novel national dataset.

Main Methods:

• Utilized a unique national dataset combining remittance data with patient demographics.
• Conducted a descriptive analysis to identify patterns in claim denial correction rates.

Main Results:

• Patients from historically disadvantaged racial/ethnic groups and lower household incomes ($<50,000/year) bore the brunt of claim denials.
• Lower-income patients were least likely to have denials contested or cost-sharing reduced.
• Racial minority patients had higher rates of cost-sharing reduction but lower average savings per contested denial compared to non-Hispanic White patients.

Conclusions:

• Significant socioeconomic and racial disparities exist in the burden of insurance claim denials and their resolution.
• Policy interventions are needed to support error correction and prevent claim denials to promote equitable healthcare access.