Physicians Concerned About Increase in Health Care Denials Driven by Prior Authorization

By Consumers for Quality Care, on October 16, 2024

Nearly three out of four providers report that health care denials have increased substantially from just two years ago, according to a survey conducted by Experian Health’s 2024 State of Claims and reported by Healthcare Dive.

According to the same survey two years ago, less than half of physicians reported that health care denials were increasing. Additionally, nearly 40 percent of physicians now report their claims are denied at least 10 percent of the time.

Physicians cited prior-authorization requirements, errors in data reporting, and payer policies as some of the reasons for the increase in denials. Providers report that the wait time to be reimbursed from payers has also increased, with some concerned that insurers ultimately won’t reimburse their claims as promised.

“We had hoped to see a decrease in claim denials from our previous survey, but it’s clear these significant challenges are continuing, adding immense pressure on providers to improve their revenue cycle management processes,” said Clarissa Riggins, Chief Product Officer at Experian. Most physicians are making reducing denials a priority in their practice, looking at ways to streamline the process on their end.

CQC urges both lawmakers and insurers to eliminate needless, burdensome processes that prevent consumers from receiving the medical care they need.