Health Insurance Claim Denial Rates Range from 13% to 35% by Insurer
3 hours ago
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- Health insurance claim denial rates on the Affordable Care Act marketplace in 2024 varied significantly by insurer, ranging from 13% to 35%.
- The national average denial rate for in-network claims was 19%, equating to roughly 85 million denials, but the specific insurer greatly influences individual outcomes.
- Largest insurers like Blue Cross Blue Shield of Alabama and UnitedHealth had among the highest denial rates, each rejecting about one-third of in-network claims.
- Denial rates are not correlated with insurer size; some large insurers, such as Centene's Ambetter and GuideWell's Florida Blue, had low denial rates around 13-14%.
- Most denials are administrative, with only about 5% due to care deemed not medically necessary, and the largest category (36%) was unexplained as 'other'.
- Fewer than 1% of denied claims are appealed, and about two-thirds of appeals are unsuccessful, making denials typically final.
- Data is limited to HealthCare.gov insurers and excludes other coverage types, with reporting inconsistencies, but still highlights significant insurer-based variation.