Massachusetts Commercial Health Plans Denied 20% Of Claims In 2024

Massachusetts commercial health insurers denied 20.4% of the 45.9 million claims submitted in 2024, according to an analysis by the Massachusetts Health Policy Commission (HPC).

Across five claim categories, denial rates ranged from 10.0% for mental health professional claims to 23% for institutional outpatient medical/surgical claims. Other denial rates included 15% for laboratory (medical/surgical) claims, 16% for addiction treatment professional claims, and 22% for professional medical/surgical claims.

Claims may be denied for a variety of reasons, including lack of prior authorization, lack of medical necessity, services deemed experimental or investigational, member ineligibility, non-covered . . .