Residents challenged 41K coverage denials in 2022

New Yorkers filed nearly 41,000 grievances to challenge health coverage denials last year amid mounting concerns about the skyrocketing cost of medical care, drugs and insurance premiums, state data show.

Strikingly, that grievance total is about 46% higher than the average number filed annually during the five years prior, according to a USA TODAY Network analysis, suggesting current economic conditions and corporate policies are fueling more clashes over insurance coverage.

A woman looks over her health insurance benefit comparison chart which shows out-of-network coverages dropped at her home office.

For consumers, details of those grievances, as well as thousands of other forms of health coverage complaints, offered key insights into potential systemic issues at health plans.

Further, the complaint data becomes increasingly valuable as open enrollment begins this fall and New Yorkers compare health plans. At the same time, insurance premium rates on average will rise double-digit percentages in 2024, raising the stakes.

How many insurance denials get reversed in NY?

Mar 24, 2023; Millwood, NY, USA; Gianluca Cefalo, 12, of Millwood, NY, pulls a syringe of insulin for use in an Omnipod 5 insulin pump. While the three largest makers of insulin have announced plans to slash prices, the cost of the medication is just one of many expenses people with diabetes must cover.  A dispute between the families health insurer and the company that makes the pump leaves them with a monthly bill of $872 for his care. Mandatory Credit: John Meore-USA TODAY

Last year, about 10,400 grievances, or one in four cases filed by consumers and health providers, resulted in the initial insurance coverage denial being reversed.

That reversal rate of about 25% fell below the nearly 30% average over the five years prior, the analysis found, but state regulators noted there is no “ideal” reversal rate.

Read More: Residents challenged 41K coverage denials in 2022

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