Health insurance claim denials in the United States

Public outrage with the American healthcare system was magnified by the recent murder of UnitedHealthcare insurance CEO Brian Thompson. A large portion of the discussions online focused on health insurance barriers like claims denials or delays, or a health insurer's power to refuse to pay for healthcare services. AvMed and UnitedHealthcare were the firms that had the highest claim denials rates in the United States. Moreover, six in ten individuals in the U.S. experienced delay in care due to insurers denial in 2023.

Most common reason for health insurance claim denial
Lack of prior authorizatio

Average dollar threshold above which medical claim denials by Medicaid
*******USD

Medicare claims denial rate
***%

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Current statistics on this topic

Public Health Programs

Average denial rates for in-network claims by ACA issuers in the U.S. 2023, by state

Private Health Insurance

Major medical insurance companies with highest claim denial rates in the U.S. 2023

Private Health Insurance

Top 5 medical insurance companies with the lowest claim denial rates in the U.S. 2023

Overview

Top 5 medical insurance companies with the lowest claim denial rates in the U.S. 2023
Top 5 medical insurance companies with the lowest claim denial rates in the U.S. 2023
Top five medical insurance companies with the lowest claim denial rates in the United States in 2023
Major medical insurance companies with highest claim denial rates in the U.S. 2023
Major medical insurance companies with highest claim denial rates in the U.S. 2023
Leading medical insurance companies with the highest claim denial rates in the United States in 2023
Threshold for prevalence of medical claim denials in the U.S. 2023, by payer type
Threshold for prevalence of medical claim denials in the U.S. 2023, by payer type
Average dollar threshold above which medical claim denials become more prevalent in the United States in 2023, by payer type (in U.S. dollars)
Share of medical claims initially denied by payers in the U.S. 2023, by payer type
Share of medical claims initially denied by payers in the U.S. 2023, by payer type
Share of medical claims initially denied by payers in the United States in 2023, by payer type
Share of post-acute medical care claim denials in the U.S. 2023, by payer type
Share of post-acute medical care claim denials in the U.S. 2023, by payer type
Share of discharges to post-acute care that were denied by payers in the United States in 2023, by payer type
Share of adults who experienced delay in care due to insurer denial in the U.S. 2023
Share of adults who experienced delay in care due to insurer denial in the U.S. 2023
Share of adults whose care was delayed as a result of coverage denial by their insurer in the United States in 2023
Share of U.S. adults with health insurance problems in past year 2023
Share of U.S. adults with health insurance problems in past year 2023
Share of insured adults in the U.S. who had the following problems with their health insurance in the past year as of 2023

ACA Marketplace denials

Number of in-network claims denied by HealthCare.gov issuers in the U.S. 2023
Number of in-network claims denied by HealthCare.gov issuers in the U.S. 2023
Number of in-network claims denied by HealthCare.gov issuers in the United States in 2023 (in millions)
Share of in-network claims denied by HealthCare.gov issuers in the U.S. 2015-2023
Share of in-network claims denied by HealthCare.gov issuers in the U.S. 2015-2023
Share of in-network claims denied by HealthCare.gov issuers in the United States from 2015 to 2023
Average denial rates for in-network claims by ACA issuers in the U.S. 2023, by state
Average denial rates for in-network claims by ACA issuers in the U.S. 2023, by state
Average denial rates of in-network claims by HealthCare.gov issuers in the United States in 2023, by state
Denial rates for major HealthCare.gov parent companies in the U.S. in 2023
Denial rates for major HealthCare.gov parent companies in the U.S. in 2023
Denial rates for HealthCare.gov parent companies that received more than five million claims in the United States in 2023
Average denial rates for in-network claims by ACA issuers U.S. 2023, by plan level
Average denial rates for in-network claims by ACA issuers U.S. 2023, by plan level
Average denial rates of in-network claims by HealthCare.gov issuers in the United States in 2023, by plan level
Share of denial rates for in-network claims by ACA issuers U.S. 2023, by reason
Share of denial rates for in-network claims by ACA issuers U.S. 2023, by reason
Distribution of denied in-network claims by HealthCare.gov issuers in the United States in 2023, by reasons for denial

Prior autherization

Most common reasons why coverage is denied by medical insurers in the U.S. 2023
Most common reasons why coverage is denied by medical insurers in the U.S. 2023
Most common reasons why health insurance claims are denied by insurers in the United States in 2023
Number of prior authorization determinations for MA plans in U.S. 2019-2023
Number of prior authorization determinations for MA plans in U.S. 2019-2023
Total number of prior authorization determinations for Medicare Advantage (MA) plans in the U.S. from 2019 to 2023
Prior authorization denial rates among Medicare Advantage firms in the U.S. in 2023
Prior authorization denial rates among Medicare Advantage firms in the U.S. in 2023
Share of prior authorization denial rates among selected Medicare Advantage (MA) firms in the U.S. in 2023
Time taken to complete and number of PAs each week for U.S. physicians 2019-2023
Time taken to complete and number of PAs each week for U.S. physicians 2019-2023
Number of hours physicians spent each week completing prior authorizations (PAs) and number completed in the United States from 2019 to 2023
Care delays associated with prior authorizations according to U.S. physicians 2023
Care delays associated with prior authorizations according to U.S. physicians 2023
Frequency of care delays associated with prior authorizations (PA) according to U.S. physicians in 2023
Patient harm associated with prior authorizations according to U.S. physicians 2023
Patient harm associated with prior authorizations according to U.S. physicians 2023
Patient harm caused by adverse events associated with prior authorizations (PA) according to U.S. physicians in 2023
Physician views on prior authorization burden by insurance plan in U.S. 2024
Physician views on prior authorization burden by insurance plan in U.S. 2024
Distribution of physicians opinion on prior authorization burden in their practice for selected health insurance plans in the U.S. in 2024
Physician views on care delays due to prior authorization in the U.S. 2024
Physician views on care delays due to prior authorization in the U.S. 2024
Distribution of physicians' opinion on delay in access to necessary care among patients who require prior authorization (PA) in the U.S. in 2024
Physician views on treatment abandonment due to prior authorization issues U.S. 2024
Physician views on treatment abandonment due to prior authorization issues U.S. 2024
Distribution of physicians' opinions on patients abandoning treatment due to issues with prior authorization in the U.S. in 2024

Denials appealed

Share of adults who appealed insurer denial of services in the U.S. 2023, by outcome
Share of adults who appealed insurer denial of services in the U.S. 2023, by outcome
Distribution of adults who appealed denial of services by their insurer in the United States in 2023, by outcome of appeal
Reasons for adults not appealing insurer denial of services in the U.S. in 2023
Reasons for adults not appealing insurer denial of services in the U.S. in 2023
Share of adults who did not appeal the denial of services by their insurer due to selected reasons in the United States in 2023
Share of adults who appealed insurer denial of services in the U.S. 2023
Share of adults who appealed insurer denial of services in the U.S. 2023
Share of adults who appealed denial of services by their insurer in the United States in 2023

Most common reason for health insurance claim denial
Lack of prior authorizatio

Average dollar threshold above which medical claim denials by Medicaid
*******USD

Medicare claims denial rate
***%

Key figures

The most important key figures provide you with a compact summary of the topic of "Health insurance claim denials in the U.S." and take you straight to the corresponding statistics.

- State with the highest in-network claims denials by HealthCare.gov issuers
- Alabama
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Detailed statistics
Average denial rates for in-network claims by ACA issuers in the U.S. 2023, by state
- Share of in-network claims denied by HealthCare.gov issuers
- **%
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Detailed statistics
Share of in-network claims denied by HealthCare.gov issuers in the U.S. 2015-2023
- Average denial rate of Catastrophic plan level by HealthCare.gov issuers
- **%
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Detailed statistics
Average denial rates for in-network claims by ACA issuers U.S. 2023, by plan level

- Share of Americans whose denial appeal resulted in approval of screening, procedure, or treatment
- **%
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Detailed statistics
Share of adults who appealed insurer denial of services in the U.S. 2023, by outcome
- Share of adults who were not sure about their right to appeal denial
- **%
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Detailed statistics
Reasons for adults not appealing insurer denial of services in the U.S. in 2023
- Share of Americans with public health insurance who appealed denials
- **%
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Detailed statistics
Share of adults who appealed insurer denial of services in the U.S. 2023

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Health insurance claim denials in the United States

Key insights