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Capitol Health Call
May 11, 2011

Coverage Denials

JAMA. 2011;305(18):1850. doi:10.1001/jama.2011.606

Almost 1 in 5 adults hoping to enroll in an individual private health insurance plan are denied coverage, said the Government Accountability Office (GAO), in a March 16 report to the secretaries of the departments of Health and Human Services (DHHS) and Labor (

The GAO made its finding based on data collected by the DHHS from 459 insurers operating in the individual market from January through March 2010. The 1-in-5 ratio was not found across the board among all insurers, the GAO said, noting that just over one-quarter of insurers had denial rates from 0% to 15%, while another quarter had denial rates of 40% or higher. There was little information on the reasons that applications were denied.

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