Patient Experience
Health insurance coverage is a point of frustration and financial strife for the average American. Navigating the healthcare system for a procedure is stressful enough, and insurers can make the situation confusing. It is not uncommon for a health procedure to be approved by insurance and then denied later, leaving the patient with a bill they did not anticipate. Additionally, there are a multitude of factors that could trigger a denial, including prior authorization documentation, alleged lack of medical necessity, or billing code errors.
The Commonwealth Fund reported how these denials affect Americans in their extensive 2025 Affordability Survey. In this study, they interviewed 6,353 adults, and they focused on the 4,589 respondents who had private insurance. They found that one in five U.S. working-age adults with private health insurance reported that they or a family member experienced coverage denial for a procedure recommended by a doctor in the past year. This included denials before treatment was rendered and after treatment was rendered.
Out of the focus group, 41% of people who experienced a prior authorization denial reported a delay in medical care, and 28% of people reported a health problem worsening due to the delay. More than 60% stated that this denial caused worry and anxiety. After facing coverage denial for a medical procedure they needed, some members of the focus group stated that they were avoiding seeking medically necessary care. Others cited postponing their medical procedures because of the lack of clarity in insurer coverage.
Another major issue that the focus group reported was an increase in out-of-pocket costs. Among people who had a claim deny, nearly 70% reported this costing them or their household more money than anticipated. In addition to increased financial burden, 43% of the focus group asserted that the denial they experienced led to medical debt that they still had at the time of the 2025 study.
When insurers deny treatment, members have a right to appeal the decision. However, only half of the Commonwealth focus group reported appealing their denial, and they stated that they were unsure if their appeal would make a difference. The appeal process required time, resources, and knowledge to complete, and because of these factors, some patients resorted to paying the bill instead of appealing, especially with the appeal process spanning across months on average.
Denials that occur in the behavioral healthcare system can be even more difficult to navigate for patients, since insurers were only recently mandated to grant equitable coverage to mental treatment as they did medical/surgical treatment. The Mental Health Parity and Addiction Equity Act was passed in 2008 by the federal government to prevent insurers from implementing unfair restrictions in behavioral health coverage. While the passing of the law did not end all restrictive behavioral health coverage, it gave regulatory agencies grounds to fine health insurers who violated parity law. Since the law was enacted, states have fined major insurers like Anthem BlueShield, Cigna, and Aetna for failing to comply with the parity law.
Where We Come In
Our team at Interface Billing Solutions is well-versed in denial management in the behavioral healthcare system, and we do the administrative work of minimizing patient denials for providers. Our team members have firsthand experience navigating addiction treatment and dealing with insurance coverage from the patient perspective. We also have extensive historical data from the revenue cycle management side, which we leverage to secure maximum payment for our patients’ claims. We fight to hold payors accountable to equitable coverage in our field, knowing that each bill and denial has tangible impacts on individuals struggling with their mental health. By partnering with substance abuse and mental health treatment centers, we take on the bureaucratic fight with insurance companies so our providers can focus on rendering necessary patient care.
As evidenced by the Commonwealth study, claim denials create physical, financial, and mental strain for patients seeking treatment for their health. Interface is proud to be on the side of patient advocacy, where our work challenges denial statistics and expands access to behavioral healthcare.