Low-income patients are less likely to see their insurance claim denials reversed, researchers from the University of Massachusetts Amherst and the University of Toronto found.
The new report in Health Affairs analyzed Affordable Care Act marketplace and employer-sponsored insurance claims to find disparities between income, race, education and other demographical features.
Researchers concluded low-income patients bear a larger burden for claims denials than higher-income enrollees.
“We found that patients with household incomes below $50,000 per year were not only the least likely to have their denied claims contested but also the least likely to have their claim denials reversed,” the authors said.
About 48% of patients with an income below $50,000 had claims successfully reversed. But, if a patient had a household income exceeding $100,000, claims were reversed 52% of the time.
On average, overturned claims resulted in savings of $136 on average, a decrease of 40% compared to the original costs. Women were found more likely to have claims reversed than men.
Although the study did not find a connection between education level and claims denials, it did identify a connection between claims and racial and ethnic minority patients.
Patients, and often providers on behalf of patients, try to overturn claim denials. Minority patients were less likely to have denied insurance claims contested than white enrollees, but they were also more likely to have those denials reversed.
“It is possible that minority patients were more likely to experience barriers to initiating a claim resubmission or reprocessing, including having access only to under resourced health care providers, explicit or implicit bias, or structural racism,” the researchers posed. “It is also possible that some minority patients chose to contest only claim denials that were unequivocally wrong, and thus contesting them had a high chance of success.”
The authors suggested lawmakers and regulators make billing, as well as claims protest procedures, as simple as possible, especially for low-income patients who need to contact an insurer outside of regular business hours.
A third of claim denials were due to a billing error, while a quarter of denials were a result of health plans rejecting an individual benefit. About one-fourth of denied claims were challenged and were contested less by patients with low incomes.