Almost half (44 per cent) of plan members said they’ve had a benefits claim denied, according to the 2019 Sanofi Canada health-care survey.
Among this group, 20 per cent have had a dental claim denied, followed by a prescription drug claim (15 per cent) and a claim for a paramedical service (13 per cent). More than a third (35 per cent) of those who’ve had a drug claim denied appealed the decision. And 49 per cent of this group said the decision was reversed.
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Among plan sponsors, 48 per cent said they’re unaware of when their members file an appeal for a previously denied claim. Half (55 per cent) of this group said they’d like to know the number of plan member appeals. However, fewer than a quarter (23 per cent) of all plan sponsor respondents said they know how many appears are made by plan members and 29 per cent said appeals rarely or never happen.
A third (31 per cent) of plan sponsors that said they know the number of appeals also noted the number had increased in the past several years, while 60 per cent said it had remained the same. Half (53 per cent) said the number of member appeals was a concern for their organization.
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