Updated November 2026, using 2024 claims data. Health insurers selling plans on HealthCare.gov denied 18.7% of the in-network claims they received in 2024: 84,502,662 of 451,249,490 claims. Denial rates ranged from 2.7% to 35.7% across the 157 insurers in this report, which means the company you choose can matter as much as the plan you choose.
This page ranks those insurers by in-network claim denial rate, by parent company and by state. The figures come from the federal Transparency in Coverage public use file that the Centers for Medicare & Medicaid Services (CMS) publishes for Affordable Care Act (ACA) marketplace insurers, as cleaned and compiled by KFF. They cover individual-market medical plans sold through HealthCare.gov in 30 states. States that run their own marketplaces, such as California, New York and Pennsylvania, are not included in the federal file.
Key Findings
- Nearly one in five in-network claims was denied. The in-network denial rate was 18.7%; counting out-of-network claims, insurers denied 20.4% of all claims.
- Almost no one appeals. Consumers filed internal appeals equal to 0.26% of denied claims.
- Appeals often work. Insurers reversed 32.6% of internal appeals, and independent reviewers reversed 32.8% of external appeals.
- Where you live matters. South Dakota insurers had the lowest combined in-network denial rate (6.5%); Hawaii had the highest (27.0%).
- Among large insurers, Corewell Health (Priority Health) had the lowest in-network denial rate (7.9%) and Oscar Health the highest (24.9%), among parent companies with at least 3 million in-network claims.
How to Read a Claim Denial Rate
A denial rate is the share of claims an insurer did not pay. A claim can be denied because a service was not covered, a prior authorization (advance approval from the insurer) was missing, the claim had a billing or coding error, the provider was out of network, or the insurer judged the care not medically necessary. The federal file does not say why each claim was denied, so a high rate does not prove an insurer is denying needed care. It is a signal worth checking, especially when you compare insurers in the same state.
In-network rates are the fairer comparison. Out-of-network claims are denied far more often by design, and some plans, such as HMOs, cover little or no out-of-network care.
Claim Denial Rates by Parent Company
Parent companies with at least 3 million in-network claims on HealthCare.gov in 2024, sorted from lowest to highest in-network denial rate. Parent groups are the corporate families reported to state regulators; one parent can operate several insurers in several states. For company profiles, see our List of Health Insurance Companies.
| Parent Company | States | In-Network Claims | In-Network Denial Rate |
|---|---|---|---|
| Corewell Health (Priority Health) | 1 | 4,106,893 | 7.9% |
| Elevance Health (Anthem, Wellpoint) | 5 | 14,691,239 | 8.3% |
| Baylor Scott & White Health Plan | 1 | 8,274,564 | 14.6% |
| BlueCross BlueShield of South Carolina | 1 | 11,796,220 | 15.5% |
| Arkansas Blue Cross and Blue Shield | 1 | 6,568,033 | 15.9% |
| Blue Cross Blue Shield of Michigan | 1 | 5,206,241 | 16.6% |
| Wellmark Blue Cross and Blue Shield | 2 | 4,370,998 | 17.6% |
| Louisiana Blue | 1 | 6,465,640 | 17.6% |
| CareSource | 5 | 8,845,681 | 18.0% |
| Health Care Service Corp. (Blue Cross and Blue Shield) | 3 | 68,390,522 | 18.4% |
| Centene (Ambetter) | 17 | 93,134,551 | 18.5% |
| Intermountain Health (SelectHealth) | 1 | 8,402,145 | 18.7% |
| Blue Cross and Blue Shield of Alabama | 1 | 10,704,172 | 19.0% |
| UnitedHealth Group (UnitedHealthcare) | 15 | 37,134,878 | 19.2% |
| Blue Cross NC | 1 | 16,183,703 | 19.3% |
| Highmark | 2 | 4,383,311 | 19.6% |
| Medica | 7 | 4,354,846 | 19.8% |
| BlueCross BlueShield of Tennessee | 1 | 6,270,421 | 21.1% |
| Cigna Healthcare | 7 | 17,434,556 | 21.3% |
| Community Health Choice (Harris Health) | 1 | 6,776,421 | 21.4% |
| GuideWell (Florida Blue) | 1 | 68,858,890 | 22.4% |
| Molina Healthcare | 6 | 6,278,416 | 22.4% |
| Oscar Health | 11 | 7,728,613 | 24.9% |
Claim Denial Rates by State
Combined in-network denial rate for all HealthCare.gov insurers in each state, sorted from lowest to highest.
| State | Insurers | In-Network Claims | In-Network Denial Rate |
|---|---|---|---|
| South Dakota | 3 | 1,716,452 | 6.5% |
| North Dakota | 3 | 1,432,238 | 9.8% |
| New Hampshire | 3 | 3,077,141 | 10.4% |
| Oregon | 6 | 2,552,164 | 10.9% |
| Montana | 2 | 2,012,739 | 11.6% |
| Wisconsin | 12 | 9,824,576 | 12.1% |
| Indiana | 3 | 6,461,283 | 15.2% |
| Missouri | 8 | 12,197,986 | 15.6% |
| Arkansas | 6 | 17,922,408 | 15.9% |
| South Carolina | 5 | 21,454,469 | 17.0% |
| Michigan | 7 | 13,652,457 | 17.4% |
| Wyoming | 1 | 1,305,051 | 17.6% |
| Ohio | 10 | 16,409,625 | 17.9% |
| Kansas | 6 | 6,298,697 | 18.2% |
| Oklahoma | 7 | 11,625,740 | 18.3% |
| Mississippi | 4 | 14,872,712 | 18.3% |
| Texas | 14 | 120,606,438 | 18.5% |
| Louisiana | 5 | 9,356,149 | 18.6% |
| Utah | 5 | 9,574,435 | 18.6% |
| Iowa | 3 | 4,833,668 | 18.8% |
| Alabama | 3 | 18,358,599 | 18.9% |
| Nebraska | 3 | 1,959,261 | 19.6% |
| Delaware | 3 | 2,232,506 | 19.7% |
| North Carolina | 7 | 23,717,695 | 19.9% |
| Arizona | 6 | 7,874,919 | 20.1% |
| Tennessee | 5 | 22,656,628 | 20.1% |
| West Virginia | 2 | 3,184,929 | 21.0% |
| Florida | 11 | 82,397,280 | 22.2% |
| Alaska | 2 | 946,098 | 25.3% |
| Hawaii | 2 | 735,147 | 27.0% |
Claim Denial Rates for Every HealthCare.gov Insurer
All insurers in the 2024 file, grouped by state. Rates are in-network except the all-claims column; “appeals overturned” is the share of internal appeals the insurer reversed.
| State | Insurer | Parent Company | In-Network Claims | In-Network Denial Rate | All-Claims Denial Rate | Appeals Overturned |
|---|---|---|---|---|---|---|
| Alaska | Moda Health Plan, Inc. | Moda Health | 168,684 | 17.3% | 47.0% | 48.6% |
| Alaska | Premera Blue Cross Blue Shield of Alaska | Premera Blue Cross | 777,414 | 27.0% | 28.2% | 47.6% |
| Alabama | Blue Cross and Blue Shield of Alabama | Blue Cross and Blue Shield of Alabama | 10,704,172 | 19.0% | 20.4% | 50.2% |
| Alabama | Celtic Insurance Company | Centene (Ambetter) | 1,644,320 | 21.4% | 19.9% | |
| Alabama | UnitedHealthcare Insurance Company | UnitedHealth Group (UnitedHealthcare) | 6,010,107 | 17.9% | 25.2% | 38.5% |
| Arkansas | Celtic Insurance Company | Centene (Ambetter) | 8,079,882 | 16.1% | 15.6% | 0.0% |
| Arkansas | HMO Partners, Inc. | Arkansas Blue Cross and Blue Shield | 1,506,621 | 16.5% | 16.8% | 29.1% |
| Arkansas | QCA Health Plan, Inc. | Centene (Ambetter) | 1,593,974 | 15.4% | 15.0% | 0.0% |
| Arkansas | QualChoice Life & Health Insurance Company, Inc. | Centene (Ambetter) | 1,680,519 | 15.6% | 15.1% | 0.0% |
| Arkansas | USAble HMO, Inc. | Arkansas Blue Cross and Blue Shield | 766,146 | 16.1% | 16.3% | 32.1% |
| Arkansas | USAble Mutual Insurance Company | Arkansas Blue Cross and Blue Shield | 4,295,266 | 15.6% | 15.7% | 31.6% |
| Arizona | Blue Cross and Blue Shield of Arizona, Inc. | Blue Cross Blue Shield of Arizona | 1,522,332 | 15.3% | 19.4% | 37.9% |
| Arizona | Cigna HealthCare of Arizona, Inc | Cigna Healthcare | 139,645 | 16.2% | 21.4% | 56.4% |
| Arizona | Health Net of Arizona, Inc. | Centene (Ambetter) | 3,202,241 | 18.6% | 19.4% | 2.8% |
| Arizona | Imperial Insurance Companies, Inc. | Imperial Insurance Companies | 2,393 | 33.1% | 37.6% | |
| Arizona | Oscar Health Plan, Inc. | Oscar Health | 292,877 | 28.1% | 34.6% | 20.7% |
| Arizona | UnitedHealthcare of Arizona, Inc. | UnitedHealth Group (UnitedHealthcare) | 2,715,431 | 23.8% | 28.4% | 38.1% |
| Delaware | AmeriHealth Caritas VIP Next, Inc. | Independence Health Group (AmeriHealth Caritas) | 165,638 | 28.0% | 29.6% | 45.2% |
| Delaware | Celtic Insurance Company | Centene (Ambetter) | 24,728 | 28.2% | 28.7% | |
| Delaware | Highmark BCBSD Inc. | Highmark | 2,042,140 | 19.0% | 19.4% | 30.6% |
| Florida | AmeriHealth Caritas Florida, Inc. | Independence Health Group (AmeriHealth Caritas) | 79,451 | 25.7% | 30.5% | |
| Florida | AvMed, Inc. | Sentara Health Plans | 431,996 | 27.3% | 28.7% | |
| Florida | Blue Cross and Blue Shield of Florida | GuideWell (Florida Blue) | 22,220,889 | 19.1% | 19.4% | 47.6% |
| Florida | Capital Health Plan | GuideWell (Florida Blue) | 540,104 | 6.5% | 7.1% | 33.9% |
| Florida | Cigna Health and Life Insurance Company | Cigna Healthcare | 4,620,013 | 20.0% | 22.2% | 32.1% |
| Florida | Florida Health Care Plan, Inc. | GuideWell (Florida Blue) | 3,536,806 | 17.0% | 18.5% | 27.4% |
| Florida | Health First Commercial Plans, Inc. | Health First Health Plans | 2,123,475 | 22.4% | 25.3% | 63.3% |
| Florida | Health Options, Inc. | GuideWell (Florida Blue) | 42,561,091 | 24.7% | 24.6% | 44.8% |
| Florida | Molina Healthcare of Florida, Inc | Molina Healthcare | 1,447,710 | 23.6% | 25.7% | 23.2% |
| Florida | Sunshine State Health Plan | Centene (Ambetter) | 1,271,365 | 20.2% | 19.7% | |
| Florida | UnitedHealthcare of Florida, Inc. | UnitedHealth Group (UnitedHealthcare) | 3,564,380 | 20.2% | 26.1% | 26.1% |
| Hawaii | Hawaii Medical Service Association | HMSA (Blue Cross Blue Shield of Hawaii) | 723,658 | 27.4% | 27.3% | 50.0% |
| Hawaii | Kaiser Foundation Health Plan, Inc. | Kaiser Permanente | 11,489 | 5.1% | 7.3% | 48.5% |
| Iowa | Medica Insurance Company | Medica | 420,450 | 21.3% | 27.6% | 50.3% |
| Iowa | Oscar Insurance Company | Oscar Health | 467,434 | 25.1% | 34.4% | 29.8% |
| Iowa | Wellmark Health Plan of Iowa, Inc. | Wellmark Blue Cross and Blue Shield | 3,945,784 | 17.8% | 19.9% | 32.8% |
| Indiana | Anthem Ins Companies Inc(Anthem BCBS) | Elevance Health (Anthem, Wellpoint) | 2,552,004 | 10.5% | 22.7% | 30.6% |
| Indiana | CareSource Indiana, Inc. | CareSource | 3,524,662 | 18.1% | 21.4% | 16.6% |
| Indiana | Cigna Health and Life Insurance Company | Cigna Healthcare | 384,617 | 19.6% | 27.4% | 49.3% |
| Kansas | Blue Cross and Blue Shield of Kansas City | Blue KC | 102,463 | 20.4% | 21.8% | 38.6% |
| Kansas | Blue Cross and Blue Shield of Kansas, Inc. | Blue Cross and Blue Shield of Kansas | 1,042,704 | 12.9% | 15.6% | 55.2% |
| Kansas | Celtic Insurance Company | Centene (Ambetter) | 3,865,491 | 19.0% | 19.0% | 1.8% |
| Kansas | Medica Insurance Company | Medica | 56,889 | 24.6% | 28.2% | 44.4% |
| Kansas | Oscar Insurance Company | Oscar Health | 296,092 | 26.1% | 32.4% | 35.2% |
| Kansas | UnitedHealthcare Insurance Company | UnitedHealth Group (UnitedHealthcare) | 935,058 | 17.9% | 26.0% | 31.5% |
| Louisiana | Ambetter Health of Louisiana, Inc. | Centene (Ambetter) | 1,704,183 | 19.1% | 20.7% | |
| Louisiana | CHRISTUS Health Plan Louisiana | CHRISTUS Health Plan | 154,775 | 14.6% | 28.0% | 40.9% |
| Louisiana | HMO Louisiana, Inc. | Louisiana Blue | 5,472,870 | 18.1% | 16.6% | 33.2% |
| Louisiana | Louisiana Health Service & Indemnity Company | Louisiana Blue | 992,770 | 14.9% | 14.6% | 32.1% |
| Louisiana | UnitedHealthcare Insurance Company | UnitedHealth Group (UnitedHealthcare) | 1,031,551 | 24.1% | 35.4% | 34.9% |
| Michigan | Blue Care Network of Michigan | Blue Cross Blue Shield of Michigan | 3,398,397 | 18.5% | 20.6% | 85.7% |
| Michigan | Blue Cross Blue Shield of Michigan Mutual Insurance Company | Blue Cross Blue Shield of Michigan | 1,807,844 | 13.1% | 13.9% | 46.8% |
| Michigan | McLaren Health Plan Community | McLaren Health Plan | 100,136 | 19.9% | 25.6% | 88.2% |
| Michigan | Meridian Health Plan of Michigan, Inc. | Centene (Ambetter) | 3,404,769 | 27.7% | 25.3% | |
| Michigan | Oscar Insurance Company | Oscar Health | 54,216 | 27.3% | 32.4% | 30.7% |
| Michigan | Priority Health | Corewell Health (Priority Health) | 4,106,893 | 7.9% | 8.7% | 21.5% |
| Michigan | UnitedHealthcare Community Plan, Inc. | UnitedHealth Group (UnitedHealthcare) | 780,202 | 26.3% | 35.6% | 23.7% |
| Missouri | Blue Cross and Blue Shield of Kansas City | Blue KC | 152,989 | 20.7% | 22.1% | 33.0% |
| Missouri | Celtic Insurance Company | Centene (Ambetter) | 5,919,313 | 18.8% | 19.2% | |
| Missouri | Cox Health Systems Insurance Company | Cox Health Plans | 99,299 | 14.7% | 17.7% | 45.8% |
| Missouri | Healthy Alliance Life Co(Anthem BCBS) | Elevance Health (Anthem, Wellpoint) | 3,941,746 | 7.5% | 10.1% | 36.3% |
| Missouri | Medica Central Insurance Company | Medica | 62,815 | 21.3% | 22.6% | |
| Missouri | Medica Insurance Company | Medica | 406,622 | 23.4% | 25.5% | 48.1% |
| Missouri | Oscar Insurance Company | Oscar Health | 544,633 | 24.5% | 28.3% | 31.8% |
| Missouri | UnitedHealthcare Insurance Company | UnitedHealth Group (UnitedHealthcare) | 1,070,569 | 19.0% | 30.7% | 34.5% |
| Mississippi | Ambetter of Magnolia Inc. | Centene (Ambetter) | 11,374,142 | 16.0% | 16.5% | 0.0% |
| Mississippi | Cigna Health and Life Insurance Company | Cigna Healthcare | 2,495,922 | 27.7% | 30.5% | 48.6% |
| Mississippi | Molina Healthcare of Mississippi, Inc | Molina Healthcare | 687,896 | 20.8% | 23.0% | 62.1% |
| Mississippi | UnitedHealthcare of Mississippi, Inc. | UnitedHealth Group (UnitedHealthcare) | 314,752 | 21.4% | 26.9% | 31.1% |
| Montana | Blue Cross and Blue Shield of Montana | Health Care Service Corp. (Blue Cross and Blue Shield) | 1,143,888 | 12.5% | 13.2% | 31.0% |
| Montana | Montana Health Cooperative | Mountain Health CO-OP | 868,851 | 10.5% | 12.3% | 24.0% |
| North Carolina | Ambetter of North Carolina Inc. | Centene (Ambetter) | 4,295,438 | 21.5% | 21.0% | |
| North Carolina | AmeriHealth Caritas North Carolina, Inc. | Independence Health Group (AmeriHealth Caritas) | 387,771 | 28.2% | 30.6% | 63.5% |
| North Carolina | Blue Cross and Blue Shield of NC | Blue Cross NC | 16,183,703 | 19.3% | 19.0% | 36.1% |
| North Carolina | CareSource North Carolina Co. | CareSource | 158,212 | 28.3% | 37.0% | 13.0% |
| North Carolina | Cigna HealthCare of North Carolina, Inc. | Cigna Healthcare | 1,009,831 | 16.1% | 21.0% | 26.0% |
| North Carolina | Oscar Health Plan of North Carolina, Inc | Oscar Health | 81,081 | 21.6% | 31.2% | 36.6% |
| North Carolina | UnitedHealthcare of North Carolina, Inc | UnitedHealth Group (UnitedHealthcare) | 1,601,659 | 21.2% | 27.7% | 37.4% |
| North Dakota | Blue Cross Blue Shield of North Dakota | Blue Cross Blue Shield of North Dakota | 717,367 | 13.5% | 15.1% | 44.6% |
| North Dakota | Medica Health Plans | Medica | 72,125 | 20.9% | 23.5% | 37.5% |
| North Dakota | Sanford Health Plan | Sanford Health Plan | 642,746 | 4.4% | 5.9% | 65.3% |
| Nebraska | Blue Cross and Blue Shield of Nebraska | Blue Cross and Blue Shield of Nebraska | 590,006 | 15.6% | 18.2% | 22.8% |
| Nebraska | Medica Insurance Company | Medica | 1,322,366 | 21.3% | 23.3% | 49.3% |
| Nebraska | Oscar Insurance Company | Oscar Health | 46,889 | 21.7% | 24.9% | 46.0% |
| New Hampshire | Celtic Insurance Company | Centene (Ambetter) | 759,938 | 17.6% | 18.1% | 58.1% |
| New Hampshire | Harvard Pilgrim Health Care of NE | Point32Health | 117,211 | 28.8% | 28.8% | 33.3% |
| New Hampshire | Matthew Thornton Hlth Plan(Anthem BCBS) | Elevance Health (Anthem, Wellpoint) | 2,199,992 | 7.0% | 8.0% | 41.9% |
| Ohio | Buckeye Community Health Plan | Centene (Ambetter) | 3,673,782 | 19.5% | 20.1% | 59.5% |
| Ohio | CareSource Ohio, Inc. | CareSource | 2,814,185 | 20.0% | 23.4% | 19.0% |
| Ohio | Community Insurance Company(Anthem BCBS) | Elevance Health (Anthem, Wellpoint) | 3,535,080 | 8.3% | 12.8% | 26.8% |
| Ohio | Medical Health Insuring Corp. of Ohio | Medical Mutual of Ohio | 1,320,144 | 15.1% | 17.4% | 64.1% |
| Ohio | Molina Healthcare of Ohio, Inc. | Molina Healthcare | 1,975,213 | 21.7% | 23.7% | 50.0% |
| Ohio | Oscar Buckeye State Insurance Corp. | Oscar Health | 1,276,642 | 26.5% | 36.4% | 25.1% |
| Ohio | Oscar Insurance Corporation of Ohio | Oscar Health | 610,423 | 19.9% | 22.1% | 34.1% |
| Ohio | Paramount Insurance Company | Medical Mutual of Ohio | 110,549 | 14.2% | 15.7% | 73.3% |
| Ohio | Summa Insurance Company, Inc. | SummaCare | 197,767 | 26.1% | 29.0% | 76.8% |
| Ohio | UnitedHealthcare of Ohio, Inc. | UnitedHealth Group (UnitedHealthcare) | 895,840 | 23.2% | 33.2% | 35.0% |
| Oklahoma | Blue Cross Blue Shield of Oklahoma | Health Care Service Corp. (Blue Cross and Blue Shield) | 8,439,891 | 16.4% | 17.9% | 29.6% |
| Oklahoma | Celtic Insurance Company | Centene (Ambetter) | 1,824,797 | 24.0% | 21.5% | |
| Oklahoma | CommunityCare HMO Inc. | CommunityCare | 435,151 | 17.1% | 18.1% | 50.5% |
| Oklahoma | Medica Insurance Company | Medica | 398,541 | 26.0% | 29.0% | 63.9% |
| Oklahoma | Oscar Insurance Company | Oscar Health | 259,248 | 23.2% | 25.6% | 27.4% |
| Oklahoma | Taro Health Plan of Oklahoma, Inc. | Mending | 7,564 | 8.5% | 10.8% | |
| Oklahoma | UnitedHealthcare of Oklahoma, Inc. | UnitedHealth Group (UnitedHealthcare) | 260,548 | 22.8% | 33.7% | 19.7% |
| Oregon | BridgeSpan Health Company | Cambia (Regence) | 12,346 | 10.5% | 11.6% | |
| Oregon | Kaiser Foundation Healthplan of the NW | Kaiser Permanente | 9,923 | 7.3% | 9.2% | 43.6% |
| Oregon | Moda Health Plan, Inc. | Moda Health | 1,102,738 | 14.3% | 15.7% | 38.7% |
| Oregon | PacificSource Health Plans | PacificSource | 3,771 | 17.4% | 20.0% | 8.8% |
| Oregon | Providence Health Plan | Providence Health Plan | 410,010 | 4.0% | 8.3% | 72.1% |
| Oregon | Regence BlueCross BlueShield of Oregon | Cambia (Regence) | 1,013,376 | 9.9% | 13.3% | 14.3% |
| South Carolina | Absolute Total Care, Inc | Centene (Ambetter) | 8,043,578 | 18.3% | 17.6% | |
| South Carolina | Blue Cross and Blue Shield of South Carolina | BlueCross BlueShield of South Carolina | 11,796,220 | 15.5% | 17.3% | 41.9% |
| South Carolina | MOLINA HEALTHCARE OF SOUTH CAROLINA, INC | Molina Healthcare | 1,055,016 | 21.8% | 22.5% | 57.6% |
| South Carolina | Select Health of South Carolina | Independence Health Group (AmeriHealth Caritas) | 121,039 | 32.7% | 36.5% | 55.2% |
| South Carolina | UnitedHealthcare of South Carolina, Inc. | UnitedHealth Group (UnitedHealthcare) | 438,616 | 20.1% | 29.3% | 31.0% |
| South Dakota | Avera Health Plans, Inc. | Avera Health Plans | 436,009 | 2.7% | 3.5% | 44.8% |
| South Dakota | Sanford Health Plan | Sanford Health Plan | 855,229 | 4.1% | 5.2% | 59.7% |
| South Dakota | Wellmark of South Dakota | Wellmark Blue Cross and Blue Shield | 425,214 | 15.4% | 17.5% | 28.3% |
| Tennessee | BlueCross BlueShield of Tennessee | BlueCross BlueShield of Tennessee | 6,270,421 | 21.1% | 26.8% | 45.0% |
| Tennessee | Celtic Insurance Company | Centene (Ambetter) | 8,726,180 | 18.9% | 18.7% | |
| Tennessee | Cigna Health and Life Insurance Company | Cigna Healthcare | 4,704,089 | 20.3% | 22.2% | 52.8% |
| Tennessee | Oscar Insurance Company | Oscar Health | 798,002 | 23.5% | 28.0% | 38.3% |
| Tennessee | UnitedHealthcare Insurance Company | UnitedHealth Group (UnitedHealthcare) | 2,157,936 | 20.7% | 26.7% | 31.7% |
| Texas | Blue Cross Blue Shield of Texas | Health Care Service Corp. (Blue Cross and Blue Shield) | 58,806,743 | 18.8% | 19.4% | 50.3% |
| Texas | CHRISTUS Health Plan | CHRISTUS Health Plan | 1,206,500 | 11.7% | 17.3% | 31.4% |
| Texas | Celtic Insurance Company | Centene (Ambetter) | 16,238,521 | 16.3% | 16.2% | 61.2% |
| Texas | Cigna HealthCare of Texas, Inc. | Cigna Healthcare | 4,080,439 | 21.7% | 24.0% | 63.8% |
| Texas | Community First Insurance Plans | Community First Health Plans | 112,382 | 30.6% | 32.5% | |
| Texas | Community Health Choice, Inc. | Community Health Choice (Harris Health) | 6,776,421 | 21.4% | 24.9% | 24.7% |
| Texas | Imperial Insurance Companies, Inc. | Imperial Insurance Companies | 2,530 | 35.7% | 39.6% | |
| Texas | Moda Health Plan, Inc. | Moda Health | 142,112 | 24.3% | 28.3% | 35.9% |
| Texas | Molina Healthcare of Texas, Inc. | Molina Healthcare | 987,573 | 24.0% | 24.9% | 54.7% |
| Texas | Oscar Insurance Company | Oscar Health | 3,001,076 | 25.5% | 29.8% | 23.6% |
| Texas | Scott and White Health Plan | Baylor Scott & White Health Plan | 8,274,564 | 14.6% | 15.3% | 60.2% |
| Texas | Sendero Health Plans, Inc. | Sendero Health Plans | 471,218 | 21.5% | 22.5% | 66.7% |
| Texas | Superior Health Plan | Centene (Ambetter) | 5,807,390 | 22.2% | 19.4% | 57.4% |
| Texas | UnitedHealthcare of Texas, Inc. | UnitedHealth Group (UnitedHealthcare) | 14,698,969 | 17.4% | 24.0% | 35.0% |
| Utah | BridgeSpan Health Company | Cambia (Regence) | 7,900 | 16.6% | 20.7% | |
| Utah | Molina Healthcare of Utah | Molina Healthcare | 125,008 | 22.9% | 23.8% | 71.8% |
| Utah | Regence BlueCross BlueShield of Utah | Cambia (Regence) | 395,068 | 14.8% | 18.4% | 12.3% |
| Utah | SelectHealth, Inc. | Intermountain Health (SelectHealth) | 8,402,145 | 18.7% | 19.8% | 27.1% |
| Utah | University of Utah Health Insurance Plans | University of Utah Health Plans | 644,314 | 19.0% | 19.7% | 32.2% |
| Wisconsin | Aspirus Health Plan, Inc. | Aspirus Health Plan | 398,306 | 12.0% | 12.6% | |
| Wisconsin | Common Ground Healthcare Cooperative | CareSource | 1,504,864 | 9.6% | 11.1% | |
| Wisconsin | Compcare Health Serv Ins Co(Anthem BCBS) | Elevance Health (Anthem, Wellpoint) | 2,462,417 | 8.7% | 15.8% | 58.4% |
| Wisconsin | Dean Health Plan | Medica | 1,104,307 | 14.6% | 15.4% | 49.4% |
| Wisconsin | Group Health Cooperative of South Central Wisconsin | Group Health Cooperative of South Central Wisconsin | 207,372 | 8.9% | 9.4% | |
| Wisconsin | HealthPartners Insurance Company | HealthPartners | 466,789 | 6.5% | 6.6% | |
| Wisconsin | Medica Community Health Plan | Medica | 510,731 | 17.1% | 18.5% | 54.6% |
| Wisconsin | MercyCare HMO, Inc. | Mercy Health | 208,646 | 9.2% | 9.9% | |
| Wisconsin | Network Health Plan | Network Health | 298,634 | 16.3% | 18.5% | 38.7% |
| Wisconsin | Quartz Health Benefit Plans Corporation | Quartz Health Solutions | 696,511 | 8.2% | 8.6% | 48.0% |
| Wisconsin | Security Health Plan of Wisconsin, Inc. | Sanford Health Plan | 1,306,739 | 18.9% | 20.1% | 65.1% |
| Wisconsin | UnitedHealthcare of Wisconsin, Inc. | UnitedHealth Group (UnitedHealthcare) | 659,260 | 17.2% | 26.5% | 41.1% |
| West Virginia | CareSource West Virginia Co. | CareSource | 843,758 | 23.6% | 30.5% | 6.5% |
| West Virginia | Highmark Blue Cross Blue Shield West Virginia | Highmark | 2,341,171 | 20.1% | 20.4% | 31.5% |
| Wyoming | Blue Cross Blue Shield of Wyoming | Blue Cross Blue Shield of Wyoming | 1,305,051 | 17.6% | 18.0% | 39.9% |
What to Do if Your Claim Is Denied
- Read the explanation of benefits (EOB) and the denial letter. Each must state the reason for the denial and how to appeal.
- Call the provider’s billing office. Many denials are coding or paperwork errors the provider can fix and resubmit.
- File an internal appeal with the insurer. ACA plans must accept appeals filed within 180 days of the denial notice.
- Ask for an external review if the insurer upholds the denial. An independent reviewer decides, and the insurer must follow the decision.
- Contact your state insurance department or consumer assistance program for help at no cost.
Given how often appeals succeed and how rarely they are filed, an appeal is usually worth the effort. For more on coverage rules, see our Health Insurance Coverage hub.
Methodology and Sources
Data: CMS Transparency in Coverage public use file for plan year 2026, which reports 2024 claims for qualified health plans on HealthCare.gov, as compiled in the KFF 2024 Transparency Data Working File. KFF excluded insurers with incomplete or implausible data; those insurers do not appear here. Parent-company and state rates are Health Plan News calculations that divide total denied in-network claims by total in-network claims received. Rates cover individual-market medical plans only and do not include employer plans, Medicare or Medicaid. Insurer names are shown as reported to CMS.