Health insurer denial rates, ranked

Medicare Advantage, Medicaid, and Marketplace contracts. Rollup computed from Centene's own posted per-contract CMS-0057-F reports with full request counts (44 contracts across the Wellcare, Health Net, and Ambetter brands: 27 Medicare Advantage, 3 Medicaid plans incl. Health Net Medi-Cal, 14 marketplace issuers). Combined standard+expedited basis. By line: Medicare Advantage 12.4%, Medicaid 2.9%, marketplace (Ambetter) 24.7% standard denial. 69.0% of 40,160 reported appeals were overturned. Per-contract source links appear in the table below.

Medicare Advantage and Medicaid reporting units. Rollup computed from Kaiser Permanente's posted regional CMS-0057-F reports (10 Medicare Advantage contracts across 8 regions plus 5 state Medicaid programs). Rates vary widely by region — the Southern California MA contract reported a 19.5% standard denial rate. Decision times are published per contract only.

Medicare Advantage and Medicaid contracts. Rollup computed from Humana's 41 posted per-contract CMS-0057-F reports (32 Medicare Advantage contracts + 9 state Medicaid plans). Medicare-only: 6.9% denial rate, 64.7% of appeals overturned. Decision times are volume-weighted from whole-day per-contract values (approximate).

Medicare Advantage, Medicaid, and Marketplace reporting units. Rollup computed from Highmark's enterprise per-contract report where request counts are posted (12 of 14 reporting units: 8 Medicare Advantage contracts plus state Medicaid and marketplace units; 2 percentage-only units excluded). Combined standard+expedited basis (4.2% standard, 7.2% expedited). Appeal counts are not published at the enterprise level, so no overturn rate is derivable.

Medicare Advantage contracts. Coverage Rights rollup computed from UnitedHealthcare's 63 posted Medicare Advantage contract disclosures. The 12.9% denial rate combines 7,942,400 standard and 651,232 expedited requests. The 57.7% appeal figure combines 63,314 reversals across 109,681 standard and expedited appeals; appeal volumes are derived from UHC's posted overturned counts and percentages. UHC separately publishes a 91.7% approved headline on a different reporting basis, so the two figures should not be compared directly. Every contract row used here appears below and in the downloadable CSV.

Medicare Advantage Blue plans. HCSC's posted Medicare Advantage rollup across its Blue plans in IL, MT, NM, OK, and TX (11 contracts) — standard requests; urgent-request denial rate was 21%. Request volumes not published. Marketplace metrics posted separately per state.

Medicare Advantage contracts. Florida Blue posts per-contract percentages only (no request counts). Rates shown are enrollment-weighted averages of its two Medicare Advantage contracts (H1035, H5434; ~109K enrollees; weights: CMS Monthly Enrollment by Contract, July 2026). Marketplace issuers are reported separately and not included.

Medicare Advantage contracts, including supplemental dental. Coverage Rights rollup computed from Devoted's posted per-contract tables for 33 Medicare Advantage contracts, including supplemental dental determinations. Devoted separately publishes a 94.6% approved headline on a basis that does not include supplemental dental, so the figures are not directly comparable. Appeal-volume figures are not disclosed, so an overturn rate is not derivable.

Medicare Advantage medical-service contracts. Aetna publishes per-contract percentages only (42 Medicare Advantage contracts, medical services excluding drugs; no request counts). Rates shown are enrollment-weighted averages of Aetna's own posted per-contract figures across 40 contracts covering ~4.2M enrollees (weights: CMS Monthly Enrollment by Contract, July 2026; 2 contracts lacked published enrollment). Standard denial rates range 0–19.9% across contracts; the appeal overturn figure is Aetna's standard-track "approved after appeal" rate, weighted the same way across the 39 contracts reporting it.

Medicare Advantage contracts. Molina posts per-plan reports across its state sites, percentages only (no request counts). Rates shown are enrollment-weighted averages of Molina's own posted per-contract Medicare Advantage figures across 15 contracts covering ~148K enrollees (weights: CMS Monthly Enrollment by Contract, July 2026; 6 further contracts lacked published enrollment). Molina republishes several multi-state contracts on more than one state page; those state views are averaged so each contract is weighted once by its national enrollment. Medicaid and marketplace plans are reported separately per state and are not included in this rollup.

Medicare Advantage contracts. Elevance posts per-plan scorecards across its Anthem/Wellpoint/Simply brand sites; Medicare Advantage scorecards are percentages-only. Rates shown are enrollment-weighted averages of Elevance's own posted per-contract figures across 23 MA contracts covering ~1.2M enrollees (weights: CMS Monthly Enrollment by Contract, July 2026; 3 contracts lacked published enrollment). Medicaid and marketplace plans are reported separately per state and are not included in this rollup.

Medicare Advantage PPO and HMO contracts. Medicare Advantage rollup computed from BCBSM's posted counts for Medicare Plus Blue PPO and BCN Advantage (standard requests). About 6.5% of denials were appealed — and 88.9% of those appeals succeeded. Individual/marketplace plans reported separately (6.3–6.6% denial). Affiliate Blue Cross Complete (Medicaid) reported a 34.9% standard denial rate.

Medicare Advantage contracts. Rollup computed from Alignment's posted per-contract tables (7 Medicare Advantage contracts). About 3.8% of denials were appealed; 58.6% of those appeals succeeded.

Medicare Advantage plans. From SCAN's posted 2025 CMS report (Medicare Advantage rollup). Denial rate computed from SCAN's posted tables (1.85% standard, 2.21% expedited); about 13.5% of denials were appealed. SCAN reports decision times in whole days (mean 3 days standard, 1 day expedited).

Federally-facilitated Exchange Individual and Family Plans (CMS - IFP FFE). Federally-facilitated Exchange (FFE) Individual & Family Plan disclosure only (source title: "CMS - IFP FFE") — not Cigna employer/commercial coverage and not Medicare Advantage. Cigna reports 27% standard denials, 22% expedited denials, 16% of appeals reversed, and mean decision times of 3.95 and 1.53 days. Coverage Rights converts those times to 94.8 and 36.7 hours for consistent display. Request volumes were not published.