The denial of an insurer claim isn't necessarily the end of the line for consumers and providers, as a new study by the Government Accountability Office concludes that nearly half of them are reversed on appeal, reports the Associated Press.
Although there are disagreements over the appropriateness of a particular treatment, in many instances, claims are rejected due to missing information or billing errors.
"You've got a lot of people in America who are ultimately paying a bill they don't owe because they don't realize it's an incorrect code," said Nancy Davenport-Ennis, chief executive officer of the non-profit group the Patient Advocate Foundation. Her organization was not involved in the study.
The GAO probed claims data from several states, as well as data compiled by other organizations. It noted that in Maryland, 50 percent of all denials are reversed. Ohio posted a similar figure, with reversals occurring 48 percent of the time.
The GAO examined the issue at the behest of Congress, which wanted a clearer idea of what role rejected claims play as it crafted and passed healthcare reform legislation last year.
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