PHOENIX (AP) -- Fewer than one in five health-care appeals filed in Arizona have been successful for consumers over the past six years, according to Arizona Department of Insurance figures.

Each year, the department reviews dozens of appeals from people whose insurance companies decided not to pay for a claim or approve a medical procedure. Since 2003, the state has approved less than 3 percent of standard consumer appeals. In cases that the state to a panel of outside medical experts, about 35 percent were overturned in favor of consumers.

State officials say the success rate on appeals mainly is due to long-shot challenges that don't jibe with the terms spelled out in insurers' contracts.

"We can't overturn and make them (insurers) pay for something that is excluded," said Mary Butterfield, the department's assistant director of consumer affairs. "Many times people continue through the review process even though it is clearly excluded."

Even so, Department of Insurance officials say consumers should still pursue such challenges if they feel a claim should be paid or a procedure covered. Appeals are free.

But critics of the system say it offers little consumer protection.

Steve Ryan, an attorney who has filed several bad-faith insurance claims, said he does not encourage his clients to appeal to the state because it is so rarely successful and he doesn't believe the state investigates each case thoroughly enough.

"I don't think I've ever had one come back where there was any resolution in favor of the policyholder," Ryan said.

Department of Insurance representatives say their reviewers read insurance policies, check medical records and research laws for each case.

"We read every single piece of paper, the entire insurance policy and all of the medical records," Butterfield said. "We have to be sure everything is there."

Arizona is among 44 states that hear appeals as a means for an independent review of a dispute over coverage.

A recent study by the insurance industry group American Health Insurance Plans found that such state-administered appeals programs upheld the health insurer's decision in 59 percent of the cases in 2006.

The study said both Washington and Arizona accepted appeals for nearly all adverse health-care decisions. In 2006, Washington overturned 24 percent of insurer's decisions.

Arizona consumers have had a lower success rate, with 18 percent of cases being fully or partially overturned since 2003. That rate includes both contract reviews completed by the Department of Insurance and medical-necessity reviews done by independent medical experts.

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Information from: The Arizona Republic, http://www.azcentral.com

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