How often each health insurer denies claims, by state
Marketplace insurers must report their in-network claims received and denied, appeals filed and overturned, and external reviews to CMS. In the plan year 2026 file (2024 claims), 186 issuer-state filings in 32 states reported 84,505,304 denials on 451,278,469 claims: a pooled rate of 18.7%, median issuer 19.0%. 32.6% of the 263,181 internal appeals were overturned. This page publishes every issuer's numbers, with N, unchanged.
By state
| State | Issuers | Median denial rate | Pooled denial rate | Appeals overturned |
|---|---|---|---|---|
| Alabama | 4 | 19.0% | 18.9% | 44.0% |
| Alaska | 2 | 22.2% | 25.3% | 47.7% |
| Arizona | 7 | 21.2% | 20.1% | 30.4% |
| Arkansas | 6 | 15.8% | 15.9% | 24.7% |
| Delaware | 3 | 28.0% | 19.7% | 32.4% |
| Florida | 16 | 20.2% | 22.2% | 36.7% |
| Georgia | 0 | n/a | n/a | n/a |
| Hawaii | 2 | 16.2% | 27.0% | 49.6% |
| Illinois | 0 | n/a | n/a | n/a |
| Indiana | 5 | 18.1% | 15.2% | 19.3% |
| Iowa | 6 | 21.3% | 18.8% | 30.5% |
| Kansas | 6 | 19.7% | 18.2% | 29.4% |
| Louisiana | 6 | 18.1% | 18.6% | 33.9% |
| Michigan | 8 | 19.9% | 17.4% | 24.7% |
| Mississippi | 5 | 21.1% | 18.3% | 14.2% |
| Missouri | 8 | 19.9% | 15.6% | 32.8% |
| Montana | 3 | 11.5% | 11.6% | 24.9% |
| Nebraska | 5 | 21.3% | 19.6% | 39.0% |
| New Hampshire | 5 | 13.3% | 10.4% | 42.2% |
| North Carolina | 7 | 21.5% | 19.9% | 27.2% |
| North Dakota | 3 | 13.5% | 9.8% | 52.2% |
| Ohio | 11 | 20.0% | 17.9% | 28.4% |
| Oklahoma | 7 | 22.9% | 18.3% | 28.0% |
| Oregon | 6 | 10.2% | 10.9% | 31.7% |
| South Carolina | 6 | 20.1% | 17.0% | 31.6% |
| South Dakota | 3 | 4.1% | 6.5% | 49.2% |
| Tennessee | 6 | 20.7% | 20.1% | 31.9% |
| Texas | 18 | 21.6% | 18.5% | 36.9% |
| Utah | 6 | 18.7% | 18.6% | 26.9% |
| West Virginia | 2 | 21.8% | 21.0% | 9.4% |
| Wisconsin | 12 | 10.8% | 12.1% | 49.9% |
| Wyoming | 2 | 17.6% | 17.6% | 39.9% |
Median is across issuers with at least 1,000 in-network claims; pooled is total denied over total received. Plan year 2026 file, 2024 claims.
Highest reported denial rates, all states (top 25 ranked issuers)
| # | Issuer | State | Claims received | Denied | Denial rate | Appeals filed | Overturned |
|---|---|---|---|---|---|---|---|
| 1 | Imperial Insurance Companies, Inc. | Texas | 2,530 | 902 | 35.6% | n/a | n/a |
| 2 | Imperial Insurance Companies, Inc. | Arizona | 2,393 | 793 | 33.1% | n/a | n/a |
| 3 | Select Health of South Carolina | South Carolina | 121,039 | 39,520 | 32.6% | 29 | 55.2% |
| 4 | Community First Insurance Plans | Texas | 112,382 | 34,419 | 30.6% | n/a | n/a |
| 5 | Harvard Pilgrim Health Care of NE | New Hampshire | 117,211 | 33,754 | 28.8% | 84 | 33.3% |
| 6 | CareSource North Carolina Co. | North Carolina | 158,212 | 44,782 | 28.3% | 728 | 13.1% |
| 7 | Celtic Insurance Company | Delaware | 24,728 | 6,979 | 28.2% | n/a | n/a |
| 8 | AmeriHealth Caritas North Carolina, Inc. | North Carolina | 387,771 | 109,227 | 28.2% | 74 | 63.5% |
| 9 | Oscar Health Plan, Inc. | Arizona | 292,877 | 82,246 | 28.1% | 4,434 | 20.7% |
| 10 | AmeriHealth Caritas VIP Next, Inc. | Delaware | 165,638 | 46,346 | 28.0% | 31 | 45.2% |
| 11 | Cigna Health and Life Insurance Company | Mississippi | 2,495,922 | 691,183 | 27.7% | 257 | 48.6% |
| 12 | Meridian Health Plan of Michigan, Inc. | Michigan | 3,404,769 | 941,541 | 27.7% | 844 | n/a |
| 13 | Hawaii Medical Service Association | Hawaii | 723,658 | 198,069 | 27.4% | 104 | 50.0% |
| 14 | AvMed, Inc. | Florida | 431,996 | 118,089 | 27.3% | 25 | n/a |
| 15 | Oscar Insurance Company | Michigan | 54,216 | 14,778 | 27.3% | 596 | 30.7% |
| 16 | Premera Blue Cross Blue Shield of Alaska | Alaska | 777,414 | 210,082 | 27.0% | 187 | 47.6% |
| 17 | Oscar Buckeye State Insurance Corp. | Ohio | 1,276,642 | 337,922 | 26.5% | 18,709 | 25.1% |
| 18 | UnitedHealthcare Community Plan, Inc. | Michigan | 780,202 | 204,912 | 26.3% | 671 | 23.7% |
| 19 | Oscar Insurance Company | Kansas | 296,092 | 77,239 | 26.1% | 4,096 | 35.2% |
| 20 | Summa Insurance Company, Inc. | Ohio | 197,767 | 51,591 | 26.1% | 319 | 76.8% |
| 21 | Medica Insurance Company | Oklahoma | 398,541 | 103,679 | 26.0% | 144 | 63.9% |
| 22 | AmeriHealth Caritas Florida, Inc. | Florida | 79,451 | 20,441 | 25.7% | n/a | n/a |
| 23 | Oscar Insurance Company | Texas | 3,001,076 | 764,285 | 25.5% | 38,325 | 23.6% |
| 24 | Oscar Insurance Company | Iowa | 467,434 | 117,430 | 25.1% | 7,284 | 29.8% |
| 25 | Health Options, Inc. | Florida | 42,561,091 | 10,507,969 | 24.7% | 3,129 | 44.8% |
Sorted by reported in-network denial rate. Rank is shown only for issuers with at least 1,000 in-network claims received; smaller issuers are listed without a rank. Source: CMS Transparency in Coverage PUF.
- Reporting lag: the CMS public-use file for a plan year reports claims from two plan years earlier (the PY2026 file carries 2024 claims). These are not this year's figures.
- In-network only: the denial rate is in-network claims denied divided by in-network claims received. Out-of-network claims are shown separately where the issuer reported them.
- "Denied" is broad: CMS counts every denial, including administrative denials, duplicate submissions, ineligibility, incorrect billing and partial denials, not only medical-necessity decisions.
- Issuer level: CMS reports the counts once per issuer per state and repeats them on every plan row; plan-level counts, where present, list denials only, so no per-plan rate is computed.
- Coverage: only issuers on the federally facilitated marketplace (HealthCare.gov states) report to this file. Employer plans, Medicare and Medicaid are not included.
- No inference of intent: a higher rate can reflect the issuer's mix of claims, its billing rules or its membership as much as its coverage decisions. Compare with the state median and read the N.
Source: CMS Transparency in Coverage Public Use File (Health Insurance Exchange PUFs) · data dictionary · all Exchange PUFs.
Questions
What is the average health insurance claim denial rate?
Across 158 marketplace issuers with at least 1,000 in-network claims in the CMS plan year 2026 file (2024 claims), the median in-network denial rate is 19.0% and the pooled rate is 18.7% (84,505,304 of 451,278,469 claims). Rates vary widely by issuer and state.
How often are denials overturned on appeal?
Issuers reported 263,181 internal appeals, of which 32.6% were overturned (median issuer: 37.7%). Most denials are never appealed.
Which insurers are included?
Issuers selling individual plans on HealthCare.gov in 32 states. State-based marketplaces (for example California, New York, Colorado) run their own exchanges and are not in this CMS file. Employer plans, Medicare and Medicaid are not included.
Can I use this data?
Yes. Apellica's derived tables are CC BY 4.0; the underlying CMS file is public domain. Download the CSV, cite the page, and keep the caveats with the numbers.
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Start a free denial review →Cite: Apellica (2026). Insurer Denial Report Cards: in-network claim denial and appeal overturn rates reported by marketplace issuers to CMS, plan years 2024 and 2025 and 2026. v1.0, generated 2026-09-14. Derived from the CMS Transparency in Coverage PUF. CC-BY-4.0. https://apellica.com/insurer-denial-rates · CC BY 4.0 · corrections: editorial@apellica.com · see also the External Review Index.
By carrier family
One national page per carrier: pooled rate, three years, every state filing.