What question did this study set out to answer?

This research aims to explore the clinical and administrative aspects of overturned health insurance claim denials.

April 15, 2026

Overturned Health Insurance Claim Denials

Key Points

This research aims to explore the clinical and administrative aspects of overturned health insurance claim denials.
Conducted a case series from 2019 to 2025
Analyzed insurance claim appeals and decision reversals in New York State
Evaluated clinical and administrative characteristics of claims
Identified common reasons for claim denials
Reversal rates of denied claims varied by type of service
Clinical characteristics influenced appeal success rates

Abstract

This case series examines the clinical and administrative characteristics of insurance claim appeals, denials, and decision reversals in New York State from 2019 to 2025.

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Authors

Ayesha Rahim

Brown University

Kirsten Eom

The University of Texas Health Science Center at San Antonio

Joseph Dov Bruch

Chicago Department of Public Health

Journals

JAMA Internal Medicine

Actions

Institutions

University of Chicago

Brown University

The University of Texas Health Science Center at San Antonio

References and Citations

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Overturned Health Insurance Claim Denials

Key Points

Abstract

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Discussion

Authors

Journals

Actions

Institutions

References and Citations

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Discussion

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