The headline numbers, 2024
Denial rates by parent company, 2024
KFF Table 1, reproduced verbatim. Parent companies that received more than 5 million claims on HealthCare.gov plans in 2024, ranked by in-network denial rate.
| Parent company | States | Claims received | Claims denied | Denial rate |
|---|---|---|---|---|
| Oscar Health | 14 | 7,728,613 | 1,924,512 | 25% |
| Molina Healthcare | 6 | 6,278,416 | 1,408,843 | 22% |
| Guidewell Mutual Holding (Florida Blue) | 1 | 68,858,890 | 15,397,985 | 22% |
| Harris Health | 1 | 6,776,421 | 1,449,319 | 21% |
| Cigna Health | 7 | 17,434,556 | 3,717,198 | 21% |
| BlueCross BlueShield of Tennessee | 1 | 6,270,421 | 1,323,501 | 21% |
| Blue Cross and Blue Shield of North Carolina | 1 | 16,183,703 | 3,116,071 | 19% |
| UnitedHealth Group | 19 | 37,134,878 | 7,137,191 | 19% |
| Blue Cross Blue Shield of Alabama | 1 | 10,704,172 | 2,038,603 | 19% |
| IHC Group | 1 | 8,402,145 | 1,571,221 | 19% |
| Centene Corporation (Ambetter) | 20 | 93,134,551 | 17,226,764 | 18% |
| Health Care Service Corporation (HCSC) | 3 | 68,390,522 | 12,556,963 | 18% |
| CareSource | 5 | 8,845,681 | 1,588,363 | 18% |
| Louisiana Health Service (BCBS LA) | 1 | 6,465,640 | 1,140,936 | 18% |
| Blue Cross Blue Shield of Michigan | 1 | 5,206,241 | 866,555 | 17% |
| Arkansas Blue Cross Blue Shield | 1 | 6,568,033 | 1,041,647 | 16% |
| BlueCross BlueShield of South Carolina | 1 | 11,796,220 | 1,827,005 | 15% |
| Scott & White | 1 | 8,274,564 | 1,205,777 | 15% |
| Elevance Health (Anthem) | 7 | 14,691,239 | 1,224,517 | 8% |
Note: State-specific Blue Cross Blue Shield plans operate independently and are listed separately. Source: KFF analysis of CMS Transparency in Coverage Public Use Files, 2024 plan year.
State variation
State averages mask wide insurer-level variation. The state with the highest average in-network denial rate was Hawaii (27%); the lowest was South Dakota (7%). In Texas, where the average matches the national rate, individual insurer denial rates ranged from 12% to 36% — the highest single-insurer rate in the country.
By plan metal level
| Metal level | Denial rate |
|---|---|
| Bronze | 19% |
| Silver | 20% |
| Gold | 17% |
| Platinum | 18% |
| Catastrophic | 22% |
Catastrophic plans had the highest 2024 denial rate at 22%.
The reasons insurers cite for denial
Plan-level reporting on denial reasons remains thin: more than a third of denials fall into an unlabeled "Other" bucket, and another quarter are filed as administrative. Only 5% of in-network denials in 2024 were for "not medically necessary," despite that being the reason patients hear most.
| Reason | Share of denials |
|---|---|
| Other (reason not listed) Insurers are not required to itemize this bucket. | 36% |
| Administrative reasons Coding errors, eligibility, duplicate claims, missing info. | 25% |
| Prior authorization or referral not obtained | 9% |
| Not medically necessary | 5% |
| Excluded service / benefit exclusion | 7% |
| Other listed categories combined | 18% |
Browse the appeal playbook by reason: all denial reasons →
How often patients actually appeal
The most striking number in the dataset is not the denial rate — it's the appeal rate. Across all HealthCare.gov marketplace plans in 2024, fewer than 1% of denied claims were appealed by patients. Among the small share that were, insurers upheld 66%, meaning patients won at the internal stage roughly 34% of the time. Most denials simply go unchallenged.
External review filings
Marketplace enrollees filed 5,881 external appeals in 2024 — equal to about 4% of internal appeals that the insurer upheld. KFF notes that the rate at which external appeals were overturned could not be calculated for 2024 because of small-cell suppression in the public-use file. External review by an Independent Review Organization is binding on the insurer when the patient wins.
For the federal external-review process by plan type, see the how-to-appeal pillar.
Methodology
All figures on this page are quoted from KFF analysis of CMS Transparency in Coverage Public Use Files, 2024 plan year (published March 2026). The underlying data are the CMS Transparency in Coverage Public Use Files for the 2024 plan year, reported by HealthCare.gov qualified health plan issuers as part of the 2026 plan certification process.
Limitations called out by KFF: only HealthCare.gov marketplace plans are required to report; employer-sponsored plans, state-based exchange plans not on HealthCare.gov, and Medicare/Medicaid claims are not in this dataset. CMS does not require itemization of "Other" denials. Plan-level data covers only plans returning to the 2026 marketplace.
This page is a structured presentation of public data. No figures are modeled or estimated by claimgotdenied.com. To re-verify, follow the source link.
How to use this data
A high parent-company denial rate does not tell you whether your specific claim will be denied — but it does tell you whether the insurer has a pattern of saying no. Two practical uses:
- If your insurer is in the top tier of denial rates, file the appeal. Volume denials are often pattern denials, and pattern denials are the kind external review most often reverses.
- If the cited reason is "administrative" or "other", the first move is to call the insurer and ask which specific policy or code triggered the denial. Administrative denials often resolve with a corrected claim before a formal appeal is needed.
Upload the EOB. You get the cited policy, the reason code, and the deadline you are working against.
Sources: KFF — Claims Denials and Appeals in ACA Marketplace Plans in 2024. Last verified: 2026-06-16.