The Affordable Care Act (ACA) requires insurers to report transparency data for all non-grandfathered health plans sold on and off the Marketplace, including fully-insured and self-funded employer health plans. Partial implementation of this federal requirement began with the 2015 plan year; however, it has so far been limited to qualified health plans (QHPs) offered on the federally facilitated Marketplace, HealthCare.gov (including state-based Marketplaces that rely on HealthCare.gov for eligibility and enrollment functions). This brief analyzes federal transparency data published 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 2024.
Read the full article: Claims Denials and Appeals in ACA Marketplace Plans in 2024 //
Source: https://www.kff.org/patient-consumer-protections/claims-denials-and-appeals-in-aca-marketplace-plans-in-2024/