Do states routinely audit insurers for denying well being care claims?

Last updated: February 25, 2025 7:04 pm

Pulse Reporter 4 hours ago

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No.

Consultants mentioned they know of no states that routinely audit insurance coverage firms over denying well being care claims.

Wisconsin Gov. Tony Evers mentioned Feb. 18 he desires to make his state the primary to audit primarily based on excessive charges of declare denials and do “corrective motion” enforced via fines.

The Wisconsin insurance coverage commissioner’s workplace and specialists from the KFF well being coverage nonprofit and Georgetown College mentioned they know of no states utilizing declare denial charges to set off audits.

The Nationwide Affiliation of Insurance coverage Commissioners and the nationwide state auditors affiliation mentioned they don’t monitor whether or not states do such auditing.

ProPublica reported in 2023 it surveyed each state’s insurance coverage company and located solely 45 enforcement actions since 2018 involving denials that violated protection mandates.

Forty-five p.c of U.S. adults surveyed in 2023 mentioned they have been billed prior to now yr for a medical service they thought ought to have been free or coated by their insurance coverage.

This truth temporary is attentive to conversations reminiscent of this one.

Sources

WISN-TV: Wisconsin Gov. Tony Evers is delivering his funds handle
State of Wisconsin: Price range in Transient 2025-27
Wisconsin Gov. Tony Evers communications director Britt Cudaback: E mail, Feb. 19, 2025
KFF director of Program on Affected person and Shopper Safety Kaye Pestaina: E mail, Feb. 23, 2025
JoAnn Volk, founding father of Georgetown College’s Heart on Well being Insurance coverage Reforms: E mail, Feb. 24, 2025
Nationwide Affiliation of Insurance coverage Commissioners: E mail, Feb. 21, 2025
Nationwide Affiliation of State Auditors, Comptrollers and Treasurers: E mail, Feb. 20, 2025
ProPublica: Well being Insurers Have Been Breaking State Legal guidelines for Years
The Commonwealth Fund: Unexpected Well being Care Payments and Protection Denials by Well being Insurers within the U.S.

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Tom Kertscher joined Wisconsin Watch as a full-time reporter in October 2024. He began as a truth checker in January 2023 and contributes to our collaboration with the The Gigafact Challenge to combat misinformation on-line. Kertscher is a former longtime newspaper reporter, together with on the Milwaukee Journal Sentinel. He’s a contributing author for Milwaukee Journal and sports activities freelancer for The Related Press.

Extra by Tom Kertscher / Wisconsin Watch