Anthem Blue Cross and Blue Shield (Georgia) in-network claim denial rate: 23.7%

In the CMS Transparency in Coverage file for plan year 2024, Anthem Blue Cross and Blue Shield reported denying 904,058 of 3,813,700 in-network claims (23.7%) in Georgia, from 2022 claims. 16.7% of internal appeals were overturned (95 of 569). That is the 2nd highest reported rate of 9 ranked issuers in Georgia; the state median is 17.7%.

Denial rate

23.7%

904,058 of 3,813,700 claims

Appeals overturned

16.7%

95 of 569 filed

External review overturned

n/a

not reported

Compared with Georgia and the national median

Measure	Anthem Blue Cross and Blue Shield	Georgia median	National median
In-network denial rate	23.7%	17.7%	15.5%
In-network claims received	3,813,700	—	—
Internal appeals filed	569	—	—
Internal appeal overturn rate	16.7%	45.3%	45.9%
External reviews filed	n/a	—	—
External review overturn rate	n/a	100.0%	64.1%
Out-of-network denial rate	56.9%	—	—

Medians are across issuers with at least 1,000 in-network claims received in the same file (Georgia: 9 issuers; national: 174 issuers in 32 states). Plan year 2024 file, 2022 claims.

Read these numbers carefully

Reporting lag: the CMS public-use file for a plan year reports claims from two plan years earlier (the PY2025 file carries 2023 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), plan year 2024; data dictionary. Issuer's own claims-payment policy page: http://www.anthem.com/ms/claims/home.html.

If Anthem Blue Cross and Blue Shield denied your claim

A denial is a decision you can contest. Marketplace plans must give you at least 180 days to file an internal appeal and offer independent external review after it (45 CFR 147.136). The letter states your deadline.

Plans in this filing (55)

Where CMS lists plan-level denial counts they are shown; no plan-level rate is computed because the file does not give plan-level claims received.

Plan ID	Type	Metal	Plan-level denials (in-network)
49046GA0410014	HMO	Catastrophic	2,756
49046GA0410015	HMO	Bronze Expanded	11,363
49046GA0410022	HMO	Bronze Expanded	9,371
49046GA0410023	HMO	Silver	16,121
49046GA0410026	HMO	Bronze Expanded	26,093
49046GA0410031	HMO	Silver	32,423
49046GA0410032	HMO	Silver	98,991
49046GA0410034	HMO	Silver	55,375
49046GA0410036	HMO	Bronze Expanded	13,896
49046GA0410037	HMO	Catastrophic	6,750
49046GA0410039	HMO	Catastrophic	165
49046GA0410043	HMO	Bronze Expanded	1,471
49046GA0410063	HMO	Bronze Expanded	1,594
49046GA0410083	HMO	Bronze	12,084
49046GA0410084	HMO	Bronze	18,029
49046GA0410085	HMO	Silver	10,804
49046GA0410086	HMO	Silver	17,576
49046GA0410088	HMO	Silver	148,810
49046GA0410092	HMO	Gold	36,387
49046GA0410093	HMO	Gold	940
49046GA0410097	HMO	Gold	20,880
49046GA0410100	HMO	Bronze	2,382
49046GA0410109	HMO	Silver	17,234
49046GA0410114	HMO	Bronze Expanded	24,850
49046GA0410115	HMO	Bronze Expanded	4,441
49046GA0410120	HMO	Bronze Expanded	42,269
49046GA0410132	HMO	Silver	161,157
49046GA0410149	HMO	Silver	1,832
49046GA0410152	HMO	Silver	3,172
49046GA0410155	HMO	Silver	933
49046GA0410160	HMO	Bronze Expanded	397
49046GA0410162	HMO	Bronze Expanded	338
49046GA0410163	HMO	Bronze	448
49046GA0410164	HMO	Bronze Expanded	2,328
49046GA0410165	HMO	Catastrophic	211
49046GA0410166	HMO	Gold	1,603
49046GA0410167	HMO	Silver	1,984
49046GA0410168	HMO	Silver	9,059
49046GA0410169	HMO	Silver	2,370
49046GA0410170	HMO	Silver	14,878
49046GA0410173	HMO	Bronze Expanded	n/a
49046GA0410174	HMO	Silver	n/a
49046GA0410175	HMO	Gold	n/a
49046GA0410179	HMO	Bronze Expanded	n/a
49046GA0410180	HMO	Bronze Expanded	n/a
49046GA0410181	HMO	Bronze Expanded	n/a
49046GA0410182	HMO	Silver	n/a
49046GA0410183	HMO	Silver	n/a
49046GA0410184	HMO	Silver	n/a
49046GA0410185	HMO	Gold	n/a
49046GA0410186	HMO	Gold	n/a
49046GA0410187	HMO	Gold	n/a
49046GA0410190	HMO	Bronze Expanded	n/a
49046GA0410191	HMO	Silver	n/a
49046GA0410192	HMO	Gold	n/a

Questions

What counts as a "denied" claim in Anthem Blue Cross and Blue Shield's 23.7% rate?

Every in-network claim the issuer reported as denied in the 2022 claims year, including administrative denials, duplicates, ineligibility, incorrect billing and partial denials, not only medical-necessity decisions. The figure is in-network claims denied divided by in-network claims received, exactly as reported to CMS.

Why is the data from 2022 when the file is for plan year 2024?

CMS's Transparency in Coverage public use file for a plan year reports claims data from two plan years earlier. This is the most recent issuer-level denial data CMS publishes for marketplace plans.

Does this predict whether my Anthem Blue Cross and Blue Shield claim will be denied?

No. It is an aggregate across all of the issuer's marketplace plans in Georgia. Your own claim depends on your plan, the service and the documentation. Compare the rate with the Georgia median (17.7%) and read the N before drawing conclusions.

How do I appeal a Anthem Blue Cross and Blue Shield denial?

Read the denial letter for the reason and the deadline, request the criteria and the claim file in writing, and file an internal appeal (at least 180 days on marketplace plans under 45 CFR 147.136). In the reporting year, 16.7% of internal appeals to this issuer were overturned (95 of 569). If the internal appeal fails, independent external review is available.

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Cite: Apellica Insurer Denial Report Cards, Anthem Blue Cross and Blue Shield (Georgia), plan year 2024, from the CMS Transparency in Coverage PUF. CC BY 4.0. Download the full table as CSV or read the methodology. Corrections: editorial@apellica.com.