New Yorkers filed more than 32,000 grievances to challenge health coverage denials in 2023 amid mounting concerns about the skyrocketing cost of medical care, drugs and insurance premiums, the most recent state data show.

That grievance total was the second-highest tally since 2016, according to a USA TODAY Network analysis, suggesting current economic conditions and corporate policies are fueling more clashes over insurance coverage. It followed a historic spike in grievances filed in 2022, when challenges topped 40,000 — an increase of more than 46% from the average number filed per year.

The rise in New Yorkers fighting health insurance denials underscored growing anger and frustration nationally with the industry. That discontent was laid bare in December after the brazen killing of UnitedHealthcare CEO Brian Thompson unleashed social media scorn at his company and a U.S. health insurance industry that serves as gatekeeper to the nation's $4.5 trillion health care system.

Details of those grievances, as well as thousands of other health coverage complaints, also offered key insights to New York consumers into potential systemic issues at health plans.

The complaint data becomes increasingly valuable as insurance premium rates in New York on average have increased by double-digit percentages in recent years, raising the stakes.

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How many insurance denials get reversed in NY?

In 2023, about 13,600 grievances, or nearly 43% of total cases filed by consumers and health providers, resulted in the initial insurance coverage denial being reversed.

That reversal rate was up from the nearly 30% average over prior years, the analysis found, but state regulators noted there is no “ideal” reversal rate.

State regulators offer the following advice on interpreting reversal rates for each health plan:

• A low reversal rate may indicate the company’s initial decisions were correct, so fewer decisions require reversal.
• But an unusually low reversal rate may indicate the company does not give appropriate reconsideration to initial decisions.
• A high reversal rate may indicate a company’s grievance process is responsive to members and providers.
• But an unusually high reversal rate may indicate the company’s process for making initial decisions is flawed.
• The number of grievances filed may be higher for health insurance companies that actively promote the grievance process to members and providers.

In one health plan category, UnitedHealthcare of New York had the highest reversal rate, 99.72% of more than 7,860 grievances.

By contrast, in that same category, HIP Health Maintenance Organization's reversal rate of about 38% impacted the next-highest number of grievances, totaling 1,794. And Excellus Health Plan had the lowest reversal rate (about 31%) for its nearly 640 grievances.

How many health insurance complaints in NY?

In addition to grievances, New Yorkers filed nearly 90,000 other complaints in 2023 involving health plans in New York.

The types of filings varied from prompt pay complaints to internal and external appeals, with the number of complaints and reversal rates varying widely by health plan.

Many of the complaints involved challenges to health plans’ refusal to pay for a medical service. Most cases come after the health insurance company asserted the service was experimental, investigational, not medically necessary, a clinical trial, or a treatment for a rare disease.

For further details about complaints and reversal rates for each health plan, visit the state Department of Health website at dfs.ny.gov, or call its hotline at (800) 342-3736.

USA TODAY Network contributed reporting.