Insurers Increasingly Issue Retrospective Denials, Leaving Patients Stranded


On February 7, 2020, Kaiser Health News reported on a health insurer tactic growing in popularity: retrospective denial. A retrospective denial occurs when a patient receives prior approval from their health insurer to receive a health care treatment or service and the health insurer afterward decides that the benefit will not be covered because it is medically unnecessary or not supported by the right documentation. When the insurer refuses to pay for these benefits, patients are billed directly by the provider, resulting in enormous medical bills that they may be unable to pay. For some patients, retrospective denials are leading to medical bankruptcy.

Insurers are not typically penalized when they inappropriately deny coverage for treatments or services. However, the National Association of Insurance Commissioners is investigating retrospective denials and both the Minnesota and Pennsylvania departments of insurance have received complaints regarding the retrospective denial of prior authorizations.

Read more to see how retrospective denials are affecting patients.


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