In 2023, residents of New York lodged more than 32,000 formal complaints against health insurance denials, driven by rising worries about the escalating costs of medical services, medications, and insurance premiums, according to the latest state statistics.

This number of complaints represents the second-largest since 2016, as shown by an analysis from YSL News Network. This uptick points to ongoing economic challenges and insurance companies’ practices fueling disputes over coverage. Last year saw an unprecedented rise in complaints, surpassing 40,000, which was a significant jump of over 46% compared to the average annual filings.

The increase in New Yorkers contesting health insurance decisions reflects a broader national sentiment of dissatisfaction with the insurance sector. This anger was especially pronounced in December when the high-profile murder of UnitedHealthcare CEO Brian Thompson sparked backlash on social media directed toward his company and the U.S. health insurance industry that governs the nation’s expansive $4.5 trillion healthcare system.

Analysis of these grievances, along with a multitude of other related complaints, provided vital information for consumers in New York, revealing potential systemic problems within various health plans.

This data on complaints holds growing importance as health insurance premiums in New York have risen significantly, often by double-digit percentages in recent years, intensifying the impact of these issues.

What percentage of insurance denials are overturned in New York?

In 2023, roughly 13,600 grievances, amounting to nearly 43% of all cases submitted by consumers and healthcare providers, resulted in the original denial of insurance coverage being overturned.

This reversal rate is an increase from the previous average of around 30%, according to the analysis. Nevertheless, state officials emphasize that there’s no “ideal” rate for reversals.

State regulators advise on how to interpret these reversal rates related to each insurance provider:

• If a health plan has a low reversal rate, it could suggest that its initial decisions were correct, requiring fewer to be changed.
• Conversely, an unusually low reversal rate might mean the company isn’t adequately reevaluating its initial decisions.
• A high reversal rate may indicate that a company effectively responds to grievances from its members and providers.
• Yet, if the reversal rate is excessively high, it might suggest flaws in the initial decision-making process.
• The frequency of grievances might be higher for companies that actively encourage members and providers to file complaints.

In one specific insurance category, UnitedHealthcare of New York recorded the highest reversal rate, overturning 99.72% of over 7,860 grievances.

In contrast, HIP Health Maintenance Organization had a reversal rate of about 38% for 1,794 grievances, while Excellus Health Plan reported the lowest reversal rate at approximately 31% for nearly 640 grievances.

What is the total number of health insurance complaints in New York?

Alongside grievances, New Yorkers submitted nearly 90,000 other complaints related to health plans in 2023.

These complaints varied, covering issues from prompt payment disputes to both internal and external appeals, with the volume and reversal rates differing significantly by health provider.

Most of the complaints were centered around disputes regarding health plans’ refusals to cover particular medical services. Common reasons cited by insurers include claims that a service was experimental, investigational, not deemed medically necessary, part of a clinical trial, or linked to a rare disease.

For more information on complaints and their respective reversal rates for each health plan, please visit the New York State Department of Health at dfs.ny.gov, or contact their hotline at (800) 342-3736.