Cigna (Evernorth) claim denial rate: 21.3%
Cigna (Evernorth) issuers selling on HealthCare.gov reported denying 3,717,198 of 17,434,556 in-network claims in 2024 across 8 filings in 7 states. The pooled rate for every issuer in the file is 18.7%. 48.1% of 3,627 internal appeals were overturned.
Three years, pooled
| Claims year | Filings | In-network claims | Denied | Denial rate | Appeals | Overturned | External reviews |
|---|---|---|---|---|---|---|---|
| 2022 (PY2024 file) | 11 | 10,812,912 | 2,027,008 | 18.7% | 2,009 | 26.3% | 31 |
| 2023 (PY2025 file) | 8 | 18,151,575 | 3,777,467 | 20.8% | 3,289 | 41.2% | 14 |
| 2024 (PY2026 file) | 8 | 17,434,556 | 3,717,198 | 21.3% | 3,627 | 48.1% | 15 |
Every Cigna filing, by state (2024 claims)
Sorted by reported denial rate. Filings under 1,000 claims are shown but not ranked. Each row links to the issuer's report card with the plan list and the year-over-year detail.
| State | Issuer (as CMS prints it) | Denial rate | Prior year | Claims | Appeals | Overturned |
|---|---|---|---|---|---|---|
| Mississippi | Cigna Health and Life Insurance Company | 27.7% | 25.6% | 2,495,922 | 257 | 48.6% |
| Texas | Cigna HealthCare of Texas, Inc. | 21.7% | 22.1% | 4,080,439 | 1,184 | 63.8% |
| Tennessee | Cigna Health and Life Insurance Company | 20.3% | 18.7% | 4,704,089 | 720 | 52.8% |
| Florida | Cigna Health and Life Insurance Company | 20.0% | 20.4% | 4,620,013 | 1,210 | 32.1% |
| Indiana | Cigna Health and Life Insurance Company | 19.6% | 27.8% | 384,617 | 67 | 49.3% |
| Arizona | Cigna HealthCare of Arizona, Inc | 16.2% | 15.5% | 139,645 | 39 | 56.4% |
| North Carolina | Cigna HealthCare of North Carolina, Inc. | 16.1% | 17.2% | 1,009,831 | 150 | 26.0% |
| Florida | Cigna HealthCare of Florida, Inc. | n/a | n/a | 0 | n/a | n/a |
If Cigna denied your claim
The rules, the filing window and the next level depend on the plan you hold, not on the brand: the Cigna (Evernorth) page carries the table for every plan type Cigna administers. A denial can be appealed; the plan must give you its file and the criteria it applied.
- Cigna (Evernorth): rules by plan type and appeal guides →
- Decode the wording on the letter →
- Work out the deadline →
- Have a reviewer read the denial (free) →
Questions
What is Cigna (Evernorth)'s claim denial rate?
In the CMS Transparency in Coverage file for plan year 2026, the 8 Cigna (Evernorth) issuer filings on HealthCare.gov reported denying 3,717,198 of 17,434,556 in-network claims received in 2024: 21.3%, against a pooled rate of 18.7% for all issuers in the file. The figure includes duplicate, administrative and eligibility denials and covers Marketplace plans only.
Does Cigna's denial rate vary by state?
Yes. Among filings with at least 1,000 claims, Cigna Health and Life Insurance Company (Mississippi) reported 27.7% and Cigna HealthCare of North Carolina, Inc. (North Carolina) reported 16.1%. Each state filing is a separate legal entity with its own claims operation.
How often are Cigna appeals successful?
48.1% of the 3,627 internal appeals reported by Cigna (Evernorth) issuers in 2024 were decided in the member's favour. Members appealed 1.0 of every 1,000 denials. External reviews: 15 requested, 0 reversed the insurer.
Is this Cigna's denial rate for employer or Medicare plans?
No. The CMS file covers individual and small-group Marketplace plans sold on HealthCare.gov in 32 states. Employer plans, Medicare Advantage and Medicaid are not in it. Use it as a comparison across insurers under the same rules, not as your own plan's number.
Other carriers
Method and limits
- 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.
- Issuer filings are mapped to Cigna (Evernorth) by the issuer's legal name (conservative brand matching); a filing that is not obviously Cigna's is left out rather than guessed.
Source: CMS Transparency in Coverage Public Use File (Health Insurance Exchange PUFs). Download: CSV · methodology. Cite: Apellica Insurer Denial Report Cards, Cigna (Evernorth), plan years 2024, 2025, 2026, generated 2026-09-14. CC BY 4.0.