{"id":172,"date":"2025-01-27T14:00:11","date_gmt":"2025-01-27T15:00:11","guid":{"rendered":"http:\/\/www.vsdia.com\/?p=172"},"modified":"2025-04-24T18:36:07","modified_gmt":"2025-04-24T18:36:07","slug":"claims-denials-and-appeals-in-aca-marketplace-plans-in-2023","status":"publish","type":"post","link":"http:\/\/www.vsdia.com\/index.php\/2025\/01\/27\/claims-denials-and-appeals-in-aca-marketplace-plans-in-2023\/","title":{"rendered":"Claims Denials and Appeals in ACA Marketplace Plans in 2023"},"content":{"rendered":"<p>This brief analyzes federal transparency data released by the Centers for Medicare and Medicaid Services (CMS) on claims denials and appeals for non-group qualified health plans (QHPs) offered on HealthCare.gov in 2023.  It finds that HealthCare.gov insurers denied nearly one out of every five claims (19%) submitted for in-network services. Information about the reasons for denials is limited, and few consumers appeal claims denials.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>This brief analyzes federal transparency data released by the Centers for Medicare and Medicaid Services (CMS) on claims denials and appeals for non-group qualified health plans (QHPs) offered on HealthCare.gov in 2023. It finds that HealthCare.gov insurers denied nearly one out of every five claims (19%) submitted for in-network services. Information about the reasons for&hellip;<\/p>\n","protected":false},"author":1,"featured_media":174,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7],"tags":[],"_links":{"self":[{"href":"http:\/\/www.vsdia.com\/index.php\/wp-json\/wp\/v2\/posts\/172"}],"collection":[{"href":"http:\/\/www.vsdia.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/www.vsdia.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/www.vsdia.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/www.vsdia.com\/index.php\/wp-json\/wp\/v2\/comments?post=172"}],"version-history":[{"count":1,"href":"http:\/\/www.vsdia.com\/index.php\/wp-json\/wp\/v2\/posts\/172\/revisions"}],"predecessor-version":[{"id":173,"href":"http:\/\/www.vsdia.com\/index.php\/wp-json\/wp\/v2\/posts\/172\/revisions\/173"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/www.vsdia.com\/index.php\/wp-json\/wp\/v2\/media\/174"}],"wp:attachment":[{"href":"http:\/\/www.vsdia.com\/index.php\/wp-json\/wp\/v2\/media?parent=172"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/www.vsdia.com\/index.php\/wp-json\/wp\/v2\/categories?post=172"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/www.vsdia.com\/index.php\/wp-json\/wp\/v2\/tags?post=172"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}