Which health insurers deny the most claims?
For plans sold on HealthCare.gov, each insurer reports its in-network claims received, denied and appealed to CMS, and Apellica publishes every issuer's numbers by state: the median issuer denied roughly one in five in-network claims in the latest file, with individual issuers ranging from under 5% to well over 30%. The figure includes administrative denials and lags two years, so compare an issuer with its state median rather than reading the number alone.
What to do, in order
- Step 1
Open your state's ranking
The report cards list every marketplace issuer in the state sorted by reported denial rate, with the N and the appeal overturn rate.
- Step 2
Read the caveats
Two-year lag, in-network only, all denial types including duplicates and ineligibility, HealthCare.gov states only.
- Step 3
Weigh it with the appeal overturn rate
An issuer that denies often but reverses most appeals behaves differently from one that denies rarely and reverses nothing.
- Step 4
If you are already denied, appeal
The rate is context; the appeal is the remedy.
The deadline that applies
Not a deadline question. If you hold a denial letter, the appeal clock on that letter controls: at least 180 days to file an internal appeal on marketplace plans (45 CFR 147.136).
Calculate your date →Documents to gather
- Your insurance card (issuer name and state)
Go deeper
Related questions
Why is my employer plan not listed?
Only marketplace issuers report to this CMS file. For an employer plan, the lookup tool tells you whether it is self-funded and which rules apply.
Is a high denial rate proof of bad faith?
No. Claim mix, billing rules and membership move the number as much as coverage decisions. The pages publish the counts and the N and do not infer intent.
Sources
Share your denial and ask our team about appeal preparation and filing support. $0 upfront. Review the fee and terms before deciding. Apellica is not a law firm and cannot guarantee an outcome.
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