{"id":32072,"date":"2025-07-18T09:00:06","date_gmt":"2025-07-18T09:00:06","guid":{"rendered":"http:\/\/medexperts.pro\/?p=32072"},"modified":"2025-07-18T09:24:24","modified_gmt":"2025-07-18T09:24:24","slug":"heath-insurers-are-denying-more-drug-claims-data-shows","status":"publish","type":"post","link":"https:\/\/medexperts.pro\/?p=32072","title":{"rendered":"Heath Insurers Are Denying More Drug Claims, Data Shows"},"content":{"rendered":"<div><\/div>\n<p id=\"article-summary\" class=\"css-79rysd e1wiw3jv0\">Offering a rare glimpse inside the hidden world of rejected insurance claims, new data shows a steady uptick among major private insurers.<\/p>\n<section class=\"meteredContent css-1r7ky0e\">\n<div class=\"css-s99gbd StoryBodyCompanionColumn\" data-testid=\"companionColumn-0\">\n<div class=\"css-53u6y8\">\n<p class=\"css-at9mc1 evys1bk0\">Prescription drug denials by private insurers in the United States jumped 25 percent from 2016 to 2023, according to a new analysis of more than four billion claims, a practice that has contributed to <a class=\"css-yywogo\" href=\"https:\/\/www.nytimes.com\/2024\/12\/05\/nyregion\/social-media-insurance-industry-brian-thompson.html\" title>rising public outrage<\/a> about the nation\u2019s private health insurance system.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">The report, compiled for The New York Times by the medical data company Komodo Health, shows that denial rates rose from 18.3 percent to 22.9 percent. The rejections went up across many major health plans, including the country\u2019s largest private insurer, UnitedHealthcare.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">The data offers a rare look into the largely hidden world of rejected insurance claims. While some government-funded health plans are required to publish their denial rates, most private insurers keep that information confidential. Komodo draws from private databases that collect denial details from pharmacies, insurers and intermediaries.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Claim denials are \u201cquite opaque, and a lot of decisions are made by private actors,\u201d said Dr. Aaron Schwartz, a health economist at the University of Pennsylvania. \u201cThere are legitimate questions about whether they are appropriate.\u201d<\/p>\n<\/div>\n<\/div>\n<div data-testid=\"Dropzone-1\"><\/div>\n<div class=\"css-s99gbd StoryBodyCompanionColumn\" data-testid=\"companionColumn-1\">\n<div class=\"css-53u6y8\">\n<p class=\"css-at9mc1 evys1bk0\">Widespread resentment toward health insurers boiled over last December after the murder of UnitedHealthcare\u2019s chief executive, Brian Thompson. <a class=\"css-yywogo\" href=\"https:\/\/www.cnn.com\/2025\/02\/20\/health\/video\/texas-doctor-surgery-insurance-call-digvid\" title rel=\"noopener noreferrer\" target=\"_blank\">Doctors<\/a> and <a class=\"css-yywogo\" href=\"https:\/\/www.nytimes.com\/2024\/12\/10\/nyregion\/uhc-shooting-luigi-mangione-brian-thompson.html\" title>patients<\/a> alike took to social media to share stories of insurers\u2019 refusal to pay for what they said was needed medical care.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Experts who have studied denials said the skyrocketing costs of popular new weight loss medications and greater automation of the claims process with artificial intelligence may have contributed to the rising rejection rates.<\/p>\n<\/div>\n<\/div>\n<div data-testid=\"InteractiveBlock-3\">\n<section data-testid=\"inline-interactive\" id=\"insurance-denials-chart\" data-id=\"100000010271512\" data-source-id=\"100000010271512\" class=\"interactive-content interactive-size-scoop css-kqcwdy\">\n<header id=\"interactive-header\" class=\"css-obecq5 interactive-header\">\n<h2 id=\"interactive-headline\" class=\"css-4hk76s interactive-headline\">Drug denials by private plans have increased<\/h2>\n<\/header>\n<div class=\"css-17ih8de interactive-body\" data-sourceid=\"100000010271512\" id=\"embed-id-100000010271512\">\n<\/div>\n<footer id=\"interactive-footer\" class=\"css-nt2azn interactive-footer\">\n<p data-testid=\"note\" id=\"interactive-notes\" class=\"css-cudxsp interactive-notes\">Denial rates were calculated using 4.5 billion claims from commercial health plans<\/p>\n<p data-testid=\"source\" id=\"interactive-source\" class=\"css-cudxsp interactive-source\">Source: Komodo Health<\/p>\n<p data-testid=\"credit\" id=\"interactive-credit\" class=\"css-cudxsp interactive-credit\">By Sarah Kliff<\/p>\n<\/footer>\n<\/section>\n<\/div>\n<div data-testid=\"InteractiveBlock-4\">\n<section data-testid=\"inline-interactive\" id=\"datawrapper_Y1KkY\" data-id=\"100000010275439\" data-source-id=\"100000010275439\" class=\"interactive-content interactive-size-scoop css-kqcwdy\">\n<header id=\"interactive-header\" class=\"css-obecq5 interactive-header\">\n<h2 id=\"interactive-headline\" class=\"css-4hk76s interactive-headline\">Denials went up at five major health plans<\/h2>\n<\/header>\n<div class=\"css-17ih8de interactive-body\" data-sourceid=\"100000010275439\" id=\"embed-id-100000010275439\">\n<\/div>\n<footer id=\"interactive-footer\" class=\"css-nt2azn interactive-footer\">\n<p data-testid=\"source\" id=\"interactive-source\" class=\"css-cudxsp interactive-source\">Source: Komodo Health<\/p>\n<p data-testid=\"credit\" id=\"interactive-credit\" class=\"css-cudxsp interactive-credit\">By: Sarah Kliff<\/p>\n<\/footer>\n<\/section>\n<\/div>\n<div data-testid=\"Optimistic-5\">\n<div class=\"css-kbghgg\">\n<div class=\"css-121kum4\">\n<div class=\"css-171quhb\"><\/div>\n<div class=\"css-asuuk5\">\n<div class=\"css-7axq9l\" data-testid=\"optimistic-truncator-noscript\">\n<div data-testid=\"optimistic-truncator-noscript-message\" class=\"css-6yo1no\">\n<p class=\"css-3kpklk\" data-tpl=\"t\">We are having trouble retrieving the article content.<\/p>\n<p class=\"css-3kpklk\" data-tpl=\"t\">Please enable JavaScript in your browser settings.<\/p>\n<\/div>\n<\/div>\n<div class=\"css-1dv1kvn\" id=\"optimistic-truncator-a11y\">\n<hr \/>\n<p>Thank you for your patience while we verify access. If you are in Reader mode please exit and\u00a0<a href=\"https:\/\/myaccount.nytimes.com\/auth\/login?response_type=cookie&amp;client_id=vi&amp;redirect_uri=https%3A%2F%2Fwww.nytimes.com%2F2025%2F07%2F18%2Fhealth%2Fhealth-insurance-prescription-claim-denials.html&amp;asset=opttrunc\">log into<\/a>\u00a0your Times account, or\u00a0<a href=\"https:\/\/www.nytimes.com\/subscription?campaignId=89WYR&amp;redirect_uri=https%3A%2F%2Fwww.nytimes.com%2F2025%2F07%2F18%2Fhealth%2Fhealth-insurance-prescription-claim-denials.html\">subscribe<\/a>\u00a0for all of The Times.<\/p>\n<hr \/>\n<\/div>\n<div class=\"css-1g71tqy\">\n<div data-testid=\"optimistic-truncator-message\" class=\"css-6yo1no\">\n<p class=\"css-3kpklk\" data-tpl=\"t\">Thank you for your patience while we verify access.<\/p>\n<p class=\"css-3kpklk\" data-tpl=\"t\">Already a subscriber?\u00a0<a data-testid=\"log-in-link\" class=\"css-z5ryv4\" href=\"https:\/\/myaccount.nytimes.com\/auth\/login?response_type=cookie&amp;client_id=vi&amp;redirect_uri=https%3A%2F%2Fwww.nytimes.com%2F2025%2F07%2F18%2Fhealth%2Fhealth-insurance-prescription-claim-denials.html&amp;asset=opttrunc\">Log in<\/a>.<\/p>\n<p class=\"css-3kpklk\" data-tpl=\"t\">Want all of The Times?\u00a0<a data-testid=\"subscribe-link\" class=\"css-z5ryv4\" href=\"https:\/\/www.nytimes.com\/subscription?campaignId=89WYR&amp;redirect_uri=https%3A%2F%2Fwww.nytimes.com%2F2025%2F07%2F18%2Fhealth%2Fhealth-insurance-prescription-claim-denials.html\">Subscribe<\/a>.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n","protected":false},"excerpt":{"rendered":"<p>Offering a rare glimpse inside the hidden world of rejected insurance claims, new data shows a steady uptick among major private insurers.Prescription drug denials by private insurers in the United States jumped 25 percent from 2016 to 2023, according to a new analysis of more than four billion claims, a practice that has contributed to rising public outrage about the nation\u2019s private health insurance system.The report, compiled for The New York Times by the medical data company Komodo Health, shows that denial rates rose from 18.3 percent to 22.9 percent. The rejections went up across many major health plans, including the country\u2019s largest private insurer, UnitedHealthcare.The data offers a rare look into the largely hidden world of rejected insurance claims. While some government-funded health plans are required to publish their denial rates, most private insurers keep that information confidential. Komodo draws from private databases that collect denial details from pharmacies, insurers and intermediaries.Claim denials are \u201cquite opaque, and a lot of decisions are made by private actors,\u201d said Dr. Aaron Schwartz, a health economist at the University of Pennsylvania. \u201cThere are legitimate questions about whether they are appropriate.\u201dWidespread resentment toward health insurers boiled over last December after the murder of UnitedHealthcare\u2019s chief executive, Brian Thompson. Doctors and patients alike took to social media to share stories of insurers\u2019 refusal to pay for what they said was needed medical care.Experts who have studied denials said the skyrocketing costs of popular new weight loss medications and greater automation of the claims process with artificial intelligence may have contributed to the rising rejection rates.Drug denials by private plans have increased<\/p>\n<p>Denial rates were calculated using 4.5 billion claims from commercial health plansSource: Komodo HealthBy Sarah KliffDenials went up at five major health plans<\/p>\n<p>Source: Komodo HealthBy: Sarah KliffWe are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and\u00a0log into\u00a0your Times account, or\u00a0subscribe\u00a0for all of The Times.Thank you for your patience while we verify access.Already a subscriber?\u00a0Log in.Want all of The Times?\u00a0Subscribe.<\/p>\n","protected":false},"author":1,"featured_media":32074,"comment_status":"close","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[],"class_list":["post-32072","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-science"],"_links":{"self":[{"href":"https:\/\/medexperts.pro\/index.php?rest_route=\/wp\/v2\/posts\/32072","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medexperts.pro\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medexperts.pro\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medexperts.pro\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/medexperts.pro\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=32072"}],"version-history":[{"count":2,"href":"https:\/\/medexperts.pro\/index.php?rest_route=\/wp\/v2\/posts\/32072\/revisions"}],"predecessor-version":[{"id":32075,"href":"https:\/\/medexperts.pro\/index.php?rest_route=\/wp\/v2\/posts\/32072\/revisions\/32075"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medexperts.pro\/index.php?rest_route=\/wp\/v2\/media\/32074"}],"wp:attachment":[{"href":"https:\/\/medexperts.pro\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=32072"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medexperts.pro\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=32072"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medexperts.pro\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=32072"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}