Browse the evidence · sourced insurer records
Search, compare, then inspect the source.
Two kinds of denials, ranked separately. Insurers report two different kinds of denials. A claim denial is a no after care: you received the care, then the insurer refused to pay. A prior-authorization denial is a no before care: the insurer refused permission for the service. We keep them separate because they happen at different moments and use different records.
The comparable claims table currently covers 2024 activity. The newer 2025 prior-authorization postings are on the insurer report pages; 2026 activity is still being collected.
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Results identify the dataset and program before showing a denial rate.
Choose a state if you want a state-specific record. Some states use different public files; when the definition does not match, we show the source gap instead of inventing a rate.
The appeal gap · Medicare Advantage · 2024
Most prior-authorization denials were not appealed. Most appealed denials were reversed.
Source · KFF analysis of CMS Medicare Advantage data (2024)
- Published
- Jan. 28, 2026
- Capture note
- Insurer-reported to CMS; unaudited.
- Scope
- rates applied per 1,000 denials
- Public lineage
- Original source linked below. A public immutable archive and provenance ID are not yet published.
Each dot represents 4,100 prior-authorization requests that Medicare Advantage insurers denied in 2024.
885 of every 1,000 denials did not enter the formal appeal process. The published data does not say why.
115 were appealed. Insurers reversed 93 and kept 22 denials in place.
Marketplace plans: who denied the most claims after care
Share of in-network claims denied in 2024 among parent companies with more than five million HealthCare.gov claims. Nineteen companies qualify; the five highest and five lowest are shown.
| Oscar Health | 25% |
|---|---|
| Molina Healthcare | 22% |
| GuideWell (Florida Blue) | 22% |
| Harris Health | 21% |
| Cigna | 21% |
| BCBS of Michigan | 17% |
|---|---|
| Arkansas BCBS | 16% |
| BCBS of South Carolina | 15% |
| Scott & White | 15% |
| Elevance Health | 8% |
Marketplace average: 19 percent of in-network claims were denied — roughly 85 million claims. This is a 2024 Marketplace comparison, not a measure of your personal claim or an employer plan. View source → · All 19 companies →
Medicare Advantage: who denied the most permission-before-care requests
Share of prior-authorization requests denied in 2024. This is a different measure, in a different market, from the Marketplace claims table.
| UnitedHealth | 12.8% |
|---|---|
| Centene | 12.3% |
| Humana | 5.8% |
| Elevance | 4.2% |
No federal file currently gives the same insurer-by-insurer claim-denial view for Medicare Advantage. That missing comparison is itself a finding. Source: KFF analyses of CMS data, Jan. 28 and Jul. 6, 2026. View source →
One Kaiser contract: 27,992 denials, 310 appeals.
Its flagship Southern California Medicare contract denied 19.5 percent of 143,690 standard requests. One denial in ninety was appealed. A quarter of those appeals succeeded.
Source · Kaiser Permanente CMS prior-authorization reports (Southern California PDF)
- Published
- report dated Mar. 27, 2026
- Capture note
- Captured Jul. 8, 2026.
- Public lineage
- Original source linked below. A public immutable archive and provenance ID are not yet published.
Cigna’s entire disclosure is one row.
Standard requests denied: 27 percent. Appeals won by patients: 16 percent. Number of requests: not disclosed anywhere.
Source · Cigna CMS annual prior-authorization statistics, CY2025
- Published
- created Mar. 2026
- Capture note
- Captured Jul. 8, 2026.
- Public lineage
- Original source linked below. A public immutable archive and provenance ID are not yet published.
Same company, 10× spread.
Across 75 Medicare contracts, denial rates run from 2.3 percent to 22.8 percent. Which contract you’re in decides what gets approved.
Source · UnitedHealthcare CMS interoperability pages (full CY2025 summary metrics)
- Published
- 2026
- Capture note
- Rates carry broad exclusions (drugs, post-acute transitions, delegated providers); contract-level PDF blocks archival tools.
- Public lineage
- Original source linked below. A public immutable archive and provenance ID are not yet published.
Documented findings about automated decisions
The machine, in four documented facts
Source · U.S. Senate Permanent Subcommittee on Investigations, majority staff report
- Published
- Oct. 17, 2024
- Public lineage
- Original source linked below. A public immutable archive and provenance ID are not yet published.
A lawsuit alleges a 90% error rate in UnitedHealth’s nH Predict algorithm. This remains an allegation, not a court finding.
Source · Estate of Gene B. Lokken v. UnitedHealth Group, class-action complaint (allegations)
- Published
- Nov. 14, 2023
- Capture note
- Allegations, not findings.
- Public lineage
- Original source linked below. A public immutable archive and provenance ID are not yet published.
Source · KFF, MA prior authorization for post-acute care
- Published
- Jul. 6, 2026
- Public lineage
- Original source linked below. A public immutable archive and provenance ID are not yet published.
Source · CMS WISeR model; WP Intelligence (Washington Post) Texas analysis via PYMNTS
- Published
- Jun. 25, 2026
- Public lineage
- Original source linked below. A public immutable archive and provenance ID are not yet published.
Public-report check · ten insurer organizations
Did insurers publish numbers people can actually check?
We checked whether each insurer’s 2025 prior-authorization report was easy to find, included the counts the rule asks for, covered the required scope, could be read, and could be saved. This is a check of the public report — not a score for how the insurer treats patients.
| Insurer | Public-record grade | What the insurer posted | What the report still leaves out | Original file |
|---|---|---|---|---|
| Cigna | 0/5 | One line of percentages. No counts to show how large the problem was. |
| open payer source |
| CVS Health / Aetna | 1/5 | Percentages only; some figures are cut off. |
| open payer source |
| Molina Healthcare | 1/5 | A public announcement; the actual tables require a login. |
| search log on file |
| UnitedHealthcare | 2/5 | A summary is online, but detailed counts are hard to save or check. |
| open payer source |
| Centene | 2/5 | Counts exist, but they are spread across many brand websites. |
| open payer source |
| Elevance Health | 2/5 | Files exist state by state, with no single place to search. |
| search log on file |
| Highmark | 3/5 | A complete report, but two contracts repeat the same table. |
| open payer source |
| Humana | 4/5 | Complete counts and appeal results in downloadable reports. |
| open payer source |
| BCBS Michigan | 4/5 | Complete counts, appeal results, and decision times on a public page. |
| open payer source |
| Kaiser Permanente | 5/5 | Complete reports with counts in PDF and a data format. |
| open payer source |
The grade is 0–5, one point each: findable without expert help · raw counts disclosed · complete and accurate · machine-readable format · open to archival tools. Full rubric and correction path on the methodology page.