ACA insurers denied just under 1 in 5 in-network claims in 2024, similar to 2023, according to a March 24 KFF analysis.
Only 3% of the insurers had in-network denial rates of at least 30%, down from 17% of insurers in 2023. Unlisted “other” reasons led the share of denials for 2024 at 36%, followed by administrative reasons, at 25%. A lack of prior authorization or referral accounted for 9% of denials, and a lack of medical necessity accounted for 5%.
KFF reviewed CMS’ “Transparency in Coverage” public use file, which includes health insurers that have more than 1,000 claims submitted. Over 150 insurers in HealthCare.gov states met this threshold and reported data on claims received and denied in 2024. This analysis does not account for state-based exchange data.
Out of the payer parent organizations listed on HealthCare.gov with more than 5 million claims in 2024, here are the top 10 with the highest average in-network denial rates:
- Oscar Health: 25%
- Molina Healthcare: 22%
- Guidewell Mutual Holding: 22%
- Harris Health: 21%
- Cigna: 21%
- BCBS Tennessee: 21%
- BCBS North Carolina: 19%
- UnitedHealth Group: 19%
- BCBS Alabama: 19%
- IHC Group: 19%
Editor’s note: These percentages are rounded to the nearest whole percentage point.
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