New insurance tool in Pennsylvania helps consumers appeal denials

In Pennsylvania, there is a new online tool that helps people work out a dispute with their health insurance company.

It was built as an easier way for people to request a state review if they believe they've had a claim wrongly denied.

The state says that all too often, consumers are simply accepting denials by their health insurance companies.

"We saw a very small number of people who were actually challenging them, but when they did challenge them, it did look like they're getting a significant number of those denials reversed," said Pennsylvania Deputy Insurance Commissioner Shannen Logue.

More and more claims are being denied, with denials going up from 1.29 million in 2020 to 2 million in 2022.

Of those 2 million denials in 2022, only 2,165 were appealed and of those, a whopping 1,149 were overturned.

"I think that's one thing consumers should know is that, you know, we've got their back," said Logue.

The Pennsylvania Insurance Department launched a new tool this week to make filing appeals easier for consumers.

It's a state-administered, independent appeal process, and people can submit for review using a brand-new website designed to be user-friendly.

"After they complete what's called an internal appeal, so they've already gone back to their insurer, the insurer still denied it, they have the opportunity to now log a request online," Logue said.

The state will then review the appeal. The hope is with this new, seamless way to request a review, more people will find it easier to get help.

"We'll have more people getting the services and health care that they need," said Logue.

New Jersey also has an independent appeals program.

On Tuesday, Pennsylvania also announced it has extended the enrollment deadline for Pennie to January 19.

Pennie is Pennsylvania's health insurance marketplace. Right now, 9 in 10 enrollees qualify and save an average of $500 a month on health insurance plans.