Wisconsin health insurers by reported claim denial rate
12 marketplace issuers in Wisconsin reported 1,188,325 denials on 9,824,576 in-network claims from 2024 (pooled rate 12.1%). The median rate among the 12 ranked issuers is 10.8%, against a national median of 19.0% across 32 HealthCare.gov states. Of 2,083 internal appeals filed, 49.9% were overturned.
All issuers reporting in Wisconsin, plan year 2026 file
| # | Issuer | Claims received | Denied | Denial rate | Appeals filed | Overturned |
|---|---|---|---|---|---|---|
| 1 | Security Health Plan of Wisconsin, Inc. | 1,306,739 | 247,191 | 18.9% | 258 | 65.1% |
| 2 | UnitedHealthcare of Wisconsin, Inc. | 659,260 | 113,541 | 17.2% | 594 | 41.1% |
| 3 | Medica Community Health Plan | 510,731 | 87,505 | 17.1% | 227 | 54.6% |
| 4 | Network Health Plan | 298,634 | 48,655 | 16.3% | 31 | 38.7% |
| 5 | Dean Health Plan | 1,104,307 | 160,914 | 14.6% | 391 | 49.4% |
| 6 | Aspirus Health Plan, Inc. | 398,306 | 47,925 | 12.0% | 19 | n/a |
| 7 | Common Ground Healthcare Cooperative | 1,504,864 | 143,772 | 9.6% | 0 | 0.0% |
| 8 | MercyCare HMO, Inc. | 208,646 | 19,105 | 9.2% | 15 | n/a |
| 9 | Group Health Cooperative of South Central Wisconsin | 207,372 | 18,470 | 8.9% | n/a | n/a |
| 10 | Compcare Health Serv Ins Co(Anthem BCBS) | 2,462,417 | 213,637 | 8.7% | 344 | 58.4% |
| 11 | Quartz Health Benefit Plans Corporation | 696,511 | 57,350 | 8.2% | 204 | 48.0% |
| 12 | HealthPartners Insurance Company | 466,789 | 30,260 | 6.5% | n/a | n/a |
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.
Denied in Wisconsin? What to do
- Wisconsin appeal rights and regulator →
- Appeal deadline calculator →
- Have Apellica prepare the appeal ($0 upfront) →
Questions
Which Wisconsin marketplace insurer reported the highest claim denial rate?
Among issuers with at least 1,000 in-network claims, Security Health Plan of Wisconsin, Inc. reported the highest rate in the plan year 2026 file: 18.9% (247,191 of 1,306,739 claims from 2024). The Wisconsin median is 10.8%. A high rate can reflect claim mix and billing rules as much as coverage decisions.
Does a lower denial rate mean a better plan?
Not by itself. Rates include administrative denials and depend on the issuer's membership and claim mix. Use the rate alongside network, premium, formulary and the appeal overturn rate, and read the caveats.
Where does this data come from?
The CMS Transparency in Coverage public use file for plan year 2026, which reports each issuer's 2024 in-network claims received and denied, internal appeals and external reviews for plans sold on HealthCare.gov. Apellica removed stand-alone dental issuers and computed nothing beyond the reported counts.
How do I appeal a denial in Wisconsin?
File an internal appeal within the deadline on your letter (at least 180 days on marketplace plans), request the plan's criteria and claim file in writing, then use Wisconsin's external review if the plan upholds the denial. The regulator is Wisconsin Office of the Commissioner of Insurance (OCI).
Download the full table as CSV · methodology · CC BY 4.0.