Plans sold on the federal ACA marketplace are required to report transparency data, including claim denial rates. Plans on state marketplaces do not have the same requirements, according to KFF.
In 2023, ACA insurers denied 19% of in-network claims. Denial rates were slightly higher in 2023 than in 2022, when ACA insurers denied 16% of claims.
Among insurers with more than 5 million ACA claims in 2023, Blue Cross Blue Shield of Alabama had the highest denial rate, at 35%, according to KFF.
Here are the insurers that received at least 5 million claims in 2023 with the highest denial rates:
- Blue Cross Blue Shield of Alabama
In-network denial rate: 35%
- UnitedHealth Group
In-network denial rate: 33%
- Health Care Service Corp. (BCBS)
In-network denial rate: 29%
- Molina Healthcare
In-network denial rate: 26%
- Elevance Health
In-network denial rate: 23%
- CVS Health/Aetna
In-network denial rate: 22%
- BlueCross BlueShield of Tennessee
In-network denial rate: 21%
- Cigna
In-network denial rate: 21%
- CareSource
In-network denial rate: 21%
- Baylor Scott & White Health Plan
In-network denial rate: 19%
Read the full report here.
