Few Consumers Challenge Unexpected Bills, Denied Claims 

By Consumers for Quality Care, on August 28, 2024

According to a recent poll by the Commonwealth Fund, nearly half of insured, working-age adults received an unexpected medical bill or copayment in the past year, per a report from Fierce Healthcare. But of those who did, less than half (45%) challenged these unexpected bills. The rest paid their surprise bills without challenging the charges or pushing back against their insurer.  

The survey found that most of the consumers who didn’t fight back (54%) were unsure that they had a right to do so. Some said that they didn’t know who to contact to contest the bill, and many said they didn’t have time to contest it, even if they knew how.  

Sara Collins, Vice President for Healthcare Coverage and Access for the Commonwealth Fund, attributed “complex insurer billing practices and loopholes” that often confuse and deter patients from questioning medical charges. “Patients deserve better—they shouldn’t have to navigate a labyrinth to use the health insurance they and their employers are paying for, and the care their doctors are prescribing,” said Collins. 

Fortunately, the study found that when consumers do question unexpected bills or denied claims, they often win. Half of consumers who fought a denied claim eventually got some or all the services approved, while 38 percent of those that fought an unexpected bill received partial or full relief. But even when a consumer was ultimately approved for a procedure, the initial denials delayed their access to care, often hurting health care outcomes for consumers.  

CQC believes consumers shouldn’t have to struggle with their insurer to get the care they need and that consumers should have more protection against insurance company denials. Furthermore, consumers should know that they have options and rights if their insurer denies coverage.