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Research · CMS PY2025 and PY2026 files · Updated 2026-09-14

Which insurers' denial rates moved most, 2023 to 2024

149 issuer filings appear in both CMS files with at least 1,000 in-network claims. 57 denied a smaller share of claims in 2024 than in 2023, 70 a larger share. The median change was +0.3 pp. The tails are where the story is.

-28.2 pp
AmeriHealth Caritas Florida, Inc. (FL): biggest drop, 53.9% to 25.7%
79,451 in-network claims in 2024
+15.3 pp
PacificSource Health Plans (OR): biggest rise, 2.1% to 17.4%
3,771 in-network claims in 2024
57 / 70
issuer filings whose denial rate fell / rose by more than half a point
22 within half a point; median change +0.3 pp
Largest decreases in in-network denial rate (percentage points)AmeriHealth Caritas Florida, Inc. (FL)−28.2 pp 53.9% → 25.7%Blue Cross and Blue Shield of Montana (…−27.0 pp 39.5% → 12.5%UnitedHealthcare Insurance Company (AL)−23.7 pp 41.6% → 17.9%AmeriHealth Caritas VIP Next, Inc. (DE)−21.9 pp 49.9% → 28.0%UnitedHealthcare Insurance Company (KS)−17.9 pp 35.9% → 17.9%UnitedHealthcare Insurance Company (LA)−16.9 pp 41.0% → 24.1%UnitedHealthcare of Arizona, Inc. (AZ)−15.8 pp 39.6% → 23.8%Blue Cross and Blue Shield of Alabama (…−15.7 pp 34.8% → 19.0%Community Insurance Company(Anthem BCBS…−13.8 pp 22.1% → 8.3%UnitedHealthcare of Texas, Inc. (TX)−13.8 pp 31.1% → 17.3%Source: CMS Transparency in Coverage public use files. Issuer-level, self-reported, HealthCare.gov plans only; a denial includes duplicate, administrative and eligibility denials. Filings with fewer than 1,000 in-network claims are excluded from rankings.
Largest increases in in-network denial rate (percentage points)PacificSource Health Plans (OR)+15.3 pp 2.1% → 17.4%Oscar Health Plan, Inc. (AZ)+10.6 pp 17.4% → 28.1%Oscar Insurance Corporation of Ohio (OH)+10.4 pp 9.5% → 19.9%Highmark Blue Cross Blue Shield West Vi…+9.4 pp 10.7% → 20.1%Meridian Health Plan of Michigan, Inc. …+9.1 pp 18.5% → 27.7%Oscar Insurance Company (MI)+7.9 pp 19.3% → 27.3%Oscar Buckeye State Insurance Corp. (OH)+7.6 pp 18.9% → 26.5%Oscar Insurance Company (IA)+7.3 pp 17.8% → 25.1%Oscar Insurance Company (TX)+7.2 pp 18.3% → 25.5%CommunityCare HMO Inc. (OK)+6.9 pp 10.3% → 17.1%Source: CMS Transparency in Coverage public use files. Issuer-level, self-reported, HealthCare.gov plans only; a denial includes duplicate, administrative and eligibility denials. Filings with fewer than 1,000 in-network claims are excluded from rankings.

Carrier families, pooled

Issuer filings grouped by parent company where the CMS issuer name makes the parent unambiguous. Pooled across states, so the largest filings dominate each family's rate.

FamilyFilings2023 denial rate2024 denial rateChange2024 claimsAppeals overturned
Blue Cross Blue Shield plans3022.3%18.9%-3.4 pp211,027,85743.6%
Centene (Ambetter, WellCare, Celtic)2413.8%18.6%+4.8 pp94,411,19320.6%
UnitedHealthcare2033.3%19.2%-14.1 pp37,134,87834.1%
Cigna820.8%21.3%+0.5 pp17,434,55648.1%
Oscar1417.1%24.6%+7.5 pp6,451,97128.4%
Molina626.4%22.4%-3.9 pp6,278,41654.5%
Kaiser Permanente26.0%6.1%+0.1 pp21,41245.8%

Every issuer filing present in both years

IssuerState20232024ChangeClaims
AmeriHealth Caritas Florida, Inc.FL53.9%25.7%-28.2 pp79,451
Blue Cross and Blue Shield of MontanaMT39.5%12.5%-27.0 pp1,143,888
UnitedHealthcare Insurance CompanyAL41.6%17.9%-23.7 pp6,010,107
AmeriHealth Caritas VIP Next, Inc.DE49.9%28.0%-21.9 pp165,638
UnitedHealthcare Insurance CompanyKS35.9%17.9%-17.9 pp935,058
UnitedHealthcare Insurance CompanyLA41.0%24.1%-16.9 pp1,031,551
UnitedHealthcare of Arizona, Inc.AZ39.6%23.8%-15.8 pp2,715,431
Blue Cross and Blue Shield of AlabamaAL34.8%19.0%-15.7 pp10,704,172
Community Insurance Company(Anthem BCBS)OH22.1%8.3%-13.8 pp3,535,080
UnitedHealthcare of Texas, Inc.TX31.1%17.3%-13.8 pp14,698,969
UnitedHealthcare of Ohio, Inc.OH36.4%23.2%-13.2 pp895,840
Matthew Thornton Hlth Plan(Anthem BCBS)NH19.9%7.0%-12.9 pp2,199,992
UnitedHealthcare Community Plan, Inc.MI38.6%26.3%-12.4 pp780,202
UnitedHealthcare of Florida, Inc.FL32.4%20.2%-12.2 pp3,564,380
BridgeSpan Health CompanyUT27.6%16.6%-11.0 pp7,900
AmeriHealth Caritas North Carolina, Inc.NC39.1%28.2%-11.0 pp387,771
UnitedHealthcare of Mississippi, Inc.MS31.9%21.4%-10.5 pp314,752
Select Health of South CarolinaSC42.8%32.6%-10.1 pp121,039
UnitedHealthcare of Oklahoma, Inc.OK32.8%22.9%-10.0 pp260,548
UnitedHealthcare Insurance CompanyTN30.4%20.7%-9.7 pp2,157,936
UnitedHealthcare of North Carolina, IncNC29.8%21.2%-8.7 pp1,601,659
Molina Healthcare of Florida, IncFL32.1%23.6%-8.6 pp1,447,710
Cigna Health and Life Insurance CompanyIN27.8%19.6%-8.3 pp384,617
UnitedHealthcare Insurance CompanyMO26.6%19.0%-7.6 pp1,070,569
Blue Cross Blue Shield of OklahomaOK23.4%16.4%-7.0 pp8,439,891
Common Ground Healthcare CooperativeWI16.1%9.6%-6.6 pp1,504,864
Sendero Health Plans, Inc.TX28.0%21.5%-6.5 pp471,218
Anthem Health Plans of NH(Anthem BCBS)NH14.6%8.9%-5.7 pp28,677
CareSource North Carolina Co.NC33.8%28.3%-5.5 pp158,212
Molina Healthcare of UtahUT28.2%22.9%-5.3 pp125,008
Blue Cross Blue Shield of TexasTX24.0%18.8%-5.3 pp58,806,743
Scott and White Health PlanTX19.1%14.6%-4.5 pp8,274,564
AvMed, Inc.FL31.1%27.3%-3.8 pp431,996
Blue Cross and Blue Shield of South CarolinaSC19.1%15.5%-3.6 pp11,796,220
MOLINA HEALTHCARE OF SOUTH CAROLINA, INCSC25.1%21.8%-3.3 pp1,055,016
Molina Healthcare of Texas, Inc.TX27.1%24.0%-3.1 pp987,573
CHRISTUS Health PlanTX14.7%11.7%-3.0 pp1,206,500
CHRISTUS Health Plan LouisianaLA17.3%14.6%-2.7 pp154,775
Molina Healthcare of Ohio, Inc.OH24.1%21.7%-2.4 pp1,975,213
Molina Healthcare of Mississippi, IncMS23.2%20.8%-2.4 pp687,896
Blue Cross Blue Shield of WyomingWY19.2%17.6%-1.6 pp1,305,051
Blue Cross Blue Shield of Michigan Mutual Insurance CompanyMI14.5%13.1%-1.5 pp1,807,844
CareSource Ohio, Inc.OH21.4%20.0%-1.4 pp2,814,185
CareSource Indiana, Inc.IN19.4%18.1%-1.3 pp3,524,662
Capital Health PlanFL7.8%6.5%-1.3 pp540,104
Moda Health Plan, Inc.TX25.5%24.3%-1.2 pp142,112
Blue Cross Blue Shield of North DakotaND14.7%13.5%-1.2 pp717,367
Blue Cross and Blue Shield of NebraskaNE16.8%15.6%-1.2 pp590,006
Oscar Health Plan of North Carolina, IncNC22.8%21.6%-1.2 pp81,081
Paramount Insurance CompanyOH15.4%14.2%-1.1 pp110,549
HMO Partners, Inc.AR17.6%16.5%-1.1 pp1,506,621
Cigna HealthCare of North Carolina, Inc.NC17.2%16.1%-1.1 pp1,009,831
Blue Cross and Blue Shield of Arizona, Inc.AZ16.3%15.3%-0.9 pp1,522,332
Sanford Health PlanSD5.0%4.1%-0.9 pp855,229
Moda Health Plan, Inc.OR15.0%14.3%-0.7 pp1,102,738
USAble Mutual Insurance CompanyAR16.3%15.6%-0.7 pp4,295,266
Health Options, Inc.FL25.3%24.7%-0.6 pp42,561,091
CareSource West Virginia Co.WV24.1%23.6%-0.5 pp843,758
Cigna HealthCare of Texas, Inc.TX22.1%21.7%-0.5 pp4,080,439
Sanford Health PlanND4.9%4.4%-0.4 pp642,746
Cox Health Systems Insurance CompanyMO15.0%14.6%-0.3 pp99,299
Cigna Health and Life Insurance CompanyFL20.4%20.0%-0.3 pp4,620,013
Blue Cross and Blue Shield of Kansas CityKS20.7%20.4%-0.3 pp102,463
HealthPartners Insurance CompanyWI6.6%6.5%-0.2 pp466,789
Wellmark of South DakotaSD15.5%15.4%-0.1 pp425,214
Kaiser Foundation Healthplan of the NWOR7.3%7.3%+0.0 pp9,923
University of Utah Health Insurance PlansUT18.9%19.0%+0.0 pp644,314
Kaiser Foundation Health Plan, Inc.HI5.0%5.1%+0.1 pp11,489
Blue Cross and Blue Shield of Kansas CityMO20.6%20.7%+0.1 pp152,989
SelectHealth, Inc.UT18.6%18.7%+0.1 pp8,402,145
Quartz Health Benefit Plans CorporationWI8.1%8.2%+0.2 pp696,511
BlueCross BlueShield of TennesseeTN20.9%21.1%+0.2 pp6,270,421
Providence Health PlanOR3.8%4.0%+0.2 pp410,010
Anthem Ins Companies Inc(Anthem BCBS)IN10.2%10.5%+0.3 pp2,552,004
Blue Care Network of MichiganMI18.2%18.6%+0.3 pp3,398,397
Blue Cross and Blue Shield of NCNC18.9%19.3%+0.4 pp16,183,703
Healthy Alliance Life Co(Anthem BCBS)MO7.1%7.5%+0.4 pp3,941,746
Group Health Cooperative of South Central WisconsinWI8.4%8.9%+0.5 pp207,372
Regence BlueCross BlueShield of OregonOR9.4%9.9%+0.5 pp1,013,376
Wellmark Health Plan of Iowa, Inc.IA17.3%17.8%+0.6 pp3,945,784
MercyCare HMO, Inc.WI8.5%9.2%+0.6 pp208,646
Blue Cross and Blue Shield of FloridaFL18.5%19.1%+0.7 pp22,220,889
Cigna HealthCare of Arizona, IncAZ15.5%16.2%+0.7 pp139,645
Aspirus Health Plan, Inc.WI11.3%12.0%+0.7 pp398,306
Compcare Health Serv Ins Co(Anthem BCBS)WI7.7%8.7%+1.0 pp2,462,417
Security Health Plan of Wisconsin, Inc.WI17.9%18.9%+1.1 pp1,306,739
Regence BlueCross BlueShield of UtahUT13.7%14.8%+1.1 pp395,068
Blue Cross and Blue Shield of Kansas, Inc.KS11.8%12.9%+1.1 pp1,042,704
Priority HealthMI6.7%7.9%+1.2 pp4,106,893
Network Health PlanWI15.1%16.3%+1.2 pp298,634
Avera Health Plans, Inc.SD1.5%2.7%+1.2 pp436,009
Summa Insurance Company, Inc.OH24.8%26.1%+1.3 pp197,767
Medica Health PlansND19.6%20.9%+1.3 pp72,125
HMO Louisiana, Inc.LA16.6%18.1%+1.5 pp5,472,870
Louisiana Health Service & Indemnity CompanyLA13.4%14.9%+1.5 pp992,770
BridgeSpan Health CompanyOR8.9%10.5%+1.6 pp12,346
Premera Blue Cross Blue Shield of AlaskaAK25.4%27.0%+1.6 pp777,414
Cigna Health and Life Insurance CompanyTN18.7%20.3%+1.6 pp4,704,089
Oscar Insurance CompanyOK21.5%23.2%+1.7 pp259,248
Medical Health Insuring Corp. of OhioOH13.2%15.0%+1.9 pp1,320,144
Oscar Insurance CompanyTN21.6%23.5%+1.9 pp798,002
Cigna Health and Life Insurance CompanyMS25.6%27.7%+2.1 pp2,495,922
Medica Insurance CompanyOK23.9%26.0%+2.1 pp398,541
Ambetter of Magnolia Inc.MS13.7%16.0%+2.4 pp11,374,142
Medica Insurance CompanyMO20.8%23.4%+2.6 pp406,622
Oscar Insurance CompanyMO21.7%24.5%+2.7 pp544,633
Celtic Insurance CompanyOK21.3%24.0%+2.8 pp1,824,797
Medica Insurance CompanyIA18.3%21.3%+3.0 pp420,450
Florida Health Care Plan, Inc.FL14.0%17.0%+3.0 pp3,536,806
Health First Commercial Plans, Inc.FL19.3%22.4%+3.1 pp2,123,475
QCA Health Plan, Inc.AR12.3%15.4%+3.2 pp1,593,974
Medica Community Health PlanWI14.0%17.1%+3.2 pp510,731
Hawaii Medical Service AssociationHI24.2%27.4%+3.2 pp723,658
Medica Insurance CompanyKS21.4%24.6%+3.2 pp56,889
QualChoice Life & Health Insurance Company, Inc.AR12.4%15.6%+3.3 pp1,680,519
Sunshine State Health PlanFL16.9%20.2%+3.3 pp1,271,365
Harvard Pilgrim Health Care of NENH25.4%28.8%+3.3 pp117,211
Oscar Insurance CompanyNE18.3%21.7%+3.4 pp46,889
Community Health Choice, Inc.TX17.9%21.4%+3.5 pp6,776,421
Celtic Insurance CompanyTN15.3%18.9%+3.5 pp8,726,180
Absolute Total Care, IncSC14.7%18.3%+3.6 pp8,043,578
Celtic Insurance CompanyAR12.4%16.1%+3.6 pp8,079,882
Medica Insurance CompanyNE17.6%21.3%+3.7 pp1,322,366
McLaren Health Plan CommunityMI16.0%19.9%+3.9 pp100,136
Dean Health PlanWI10.3%14.6%+4.3 pp1,104,307
Celtic Insurance CompanyAL17.0%21.4%+4.5 pp1,644,320
Celtic Insurance CompanyTX11.7%16.3%+4.6 pp16,238,521
Montana Health CooperativeMT5.7%10.5%+4.8 pp868,851
Community First Insurance PlansTX25.6%30.6%+5.0 pp112,382
Buckeye Community Health PlanOH14.4%19.5%+5.0 pp3,673,782
Highmark BCBSD Inc.DE13.8%19.0%+5.2 pp2,042,140
Celtic Insurance CompanyMO13.4%18.8%+5.4 pp5,919,313
Medica Central Insurance CompanyMO15.9%21.3%+5.5 pp62,815
Celtic Insurance CompanyNH12.1%17.6%+5.5 pp759,938
Celtic Insurance CompanyKS13.5%19.0%+5.5 pp3,865,491
Health Net of Arizona, Inc.AZ13.1%18.6%+5.6 pp3,202,241
Ambetter of North Carolina Inc.NC15.3%21.5%+6.2 pp4,295,438
Oscar Insurance CompanyKS19.7%26.1%+6.4 pp296,092
Superior Health PlanTX15.3%22.2%+6.9 pp5,807,390
CommunityCare HMO Inc.OK10.3%17.1%+6.9 pp435,151
Oscar Insurance CompanyTX18.3%25.5%+7.2 pp3,001,076
Oscar Insurance CompanyIA17.8%25.1%+7.3 pp467,434
Oscar Buckeye State Insurance Corp.OH18.9%26.5%+7.6 pp1,276,642
Oscar Insurance CompanyMI19.3%27.3%+7.9 pp54,216
Meridian Health Plan of Michigan, Inc.MI18.5%27.7%+9.1 pp3,404,769
Highmark Blue Cross Blue Shield West VirginiaWV10.7%20.1%+9.4 pp2,341,171
Oscar Insurance Corporation of OhioOH9.5%19.9%+10.4 pp610,423
Oscar Health Plan, Inc.AZ17.4%28.1%+10.6 pp292,877
PacificSource Health PlansOR2.1%17.4%+15.3 pp3,771

Method

Source: CMS Transparency in Coverage public use files. Issuer-level, self-reported, HealthCare.gov plans only; a denial includes duplicate, administrative and eligibility denials. Filings with fewer than 1,000 in-network claims are excluded from rankings. A filing is included when the same issuer ID and state appear in both the PY2025 file (2023 claims) and the PY2026 file (2024 claims) with at least 1,000 in-network claims in each. Change is in percentage points of the in-network denial rate. Issuers can change how they count denials between years; a large move is a reason to look, not a verdict.

Reuse this research

Free to cite, quote, chart and republish with attribution (CC BY 4.0). Every figure is reproducible from the downloads below.

Apellica (2026). Which insurers' denial rates moved most, 2023 to 2024. https://apellica.com/research/denial-rate-changes-2026

Corrections: editorial@apellica.com · Press: press@apellica.com · Nothing here predicts an individual claim; it describes populations.

General information, not legal or medical advice. Apellica is an appeal-preparation service, not a law firm.

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