UnitedHealthcare of Ohio, Inc. (Ohio) in-network claim denial rate: 23.2%

In the CMS Transparency in Coverage file for plan year 2026, UnitedHealthcare of Ohio, Inc. reported denying 208,089 of 895,840 in-network claims (23.2%) in Ohio, from 2024 claims. 35.0% of internal appeals were overturned (330 of 944). That is the 3rd highest reported rate of 10 ranked issuers in Ohio; the state median is 20.0%.

Denial rate

23.2%

208,089 of 895,840 claims

Appeals overturned

35.0%

330 of 944 filed

External review overturned

n/a

n/a of 21 filed

Prior file (plan year 2025, 2023 claims): denial rate 36.4% (125,776 of 345,239); appeal overturn rate 47.1%.

Compared with Ohio and the national median

Measure	UnitedHealthcare of Ohio, Inc.	Ohio median	National median
In-network denial rate	23.2%	20.0%	19.0%
In-network claims received	895,840	—	—
Internal appeals filed	944	—	—
Internal appeal overturn rate	35.0%	42.5%	37.7%
External reviews filed	21	—	—
External review overturn rate	n/a	21.7%	0.0%
Out-of-network denial rate	59.4%	—	—

Medians are across issuers with at least 1,000 in-network claims received in the same file (Ohio: 10 issuers; national: 158 issuers in 32 states). Plan year 2026 file, 2024 claims.

Read these numbers carefully

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), plan year 2026; data dictionary. Issuer's own claims-payment policy page: https://www.uhc.com/transparency.

If UnitedHealthcare of Ohio, Inc. 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.

Compare this issuer

Other issuers in Ohio

Buckeye Community Health Plan 19.5%
Community Insurance Company(Anthem BCBS) 8.3%
CareSource Ohio, Inc. 20.0%
Molina Healthcare of Ohio, Inc. 21.7%
Medical Health Insuring Corp. of Ohio 15.0%
Oscar Buckeye State Insurance Corp. 26.5%
Oscar Insurance Corporation of Ohio 19.9%
AultCare Insurance Company 19.6%
Summa Insurance Company, Inc. 26.1%
Paramount Insurance Company 14.2%
Aetna Health Inc. (a PA corp.) n/a
Antidote Health Plan of Ohio n/a

UnitedHealthcare filings in other states

Plans in this filing (17)

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)
33931OH0030014	HMO	Gold	2,372
33931OH0030021	HMO	Silver	4,347
33931OH0030026	HMO	Bronze	9,322
33931OH0030030	HMO	Silver	15,230
33931OH0030031	HMO	Silver	32,941
33931OH0030032	HMO	Gold	4,566
33931OH0030035	HMO	Bronze	n/a
33931OH0030042	HMO	Gold	n/a
33931OH0030044	HMO	Bronze	n/a
33931OH0070001	HMO	Silver	9,718
33931OH0070002	HMO	Gold	8,804
33931OH0070004	HMO	Bronze	n/a
33931OH0070005	HMO	Bronze	n/a
33931OH0070006	HMO	Silver	n/a
33931OH0070007	HMO	Silver	n/a
33931OH0070008	HMO	Gold	n/a
33931OH0070009	HMO	Gold	n/a

Questions

What counts as a "denied" claim in UnitedHealthcare of Ohio, Inc.'s 23.2% rate?

Every in-network claim the issuer reported as denied in the 2024 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 2024 when the file is for plan year 2026?

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 UnitedHealthcare of Ohio, Inc. claim will be denied?

No. It is an aggregate across all of the issuer's marketplace plans in Ohio. Your own claim depends on your plan, the service and the documentation. Compare the rate with the Ohio median (20.0%) and read the N before drawing conclusions.

How do I appeal a UnitedHealthcare of Ohio, Inc. 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, 35.0% of internal appeals to this issuer were overturned (330 of 944). If the internal appeal fails, independent external review is available.

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Cite: Apellica Insurer Denial Report Cards, UnitedHealthcare of Ohio, Inc. (Ohio), plan year 2026, 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.