A CBS News analysis of about 1.3 billion federal health insurance claims during a three-year period found that insurers denied 19% on in-network claims in 2024. In 2022, the largest health care insurer, United Healthcare, denied approximately one-third of federal health insurance claims. United Healthcare claims that its initial denial rate is 10% across all of its health insurance plans.
United Healthcare said in a statement: “About 165 million Americans are enrolled in employer-sponsored health care plans, and 65% of them are enrolled in what’s called a self-insured plan. The health insurance company they select provides administrative services such as handling calls from members and paying claims. But as the phrase ‘self-insured’ suggests, it’s the employer’s funds that cover claims payments … Self-insured employers can design their health plans and determine what will and won’t be covered for their employees. It’s important to remember that your health insurer probably isn’t the one that designed it that way. Your employer did.”
While insureds can appeal the denial of their health care claim, about half of such appeals are successful, less than one percent of denied in-network claims are appealed: “All of us are vulnerable to being denied. Not all of us can weather the storms easily when it comes to appealing and overcoming these barriers. A lot of people don’t know that they even can appeal.”
The 2023 KFF Survey of Consumer Experiences with Health Insurance found that 58% of insured adults said they have experienced a problem using their health insurance, including denied claims. Four in ten (39%) of those who reported having trouble paying medical bills said that denied claims contributed to their problem.
KFF reported on January 27, 2025 that insurers reported receiving 425 million claims in 2023, with 92% (392 million claims) filed for in-network services. Of these in-network claims, 73 million were ultimately denied, resulting in an average in-network denial rate of 19%. Out-of-network claims totaled 33 million, with an overall higher denial rate of 37%. Claims that were initially denied then subsequently resubmitted and paid are not included as denied claims in the denial rate.
Of in-network claims, about 16% of denials were because the claim was for an excluded service, 9% due to lack of prior authorization or referral, and only about 6% based on medical necessity. The share of denial reasons related to administrative reasons is 18%, the most common reason aside from “other” (34%).
Of the 73 million in-network denied claims in 2023, HealthCare.gov consumers appealed 376,527 – an appeal rate of less than 1%. Insurers upheld 211,393 (56%) denials on appeal.
If you or a loved one suffered harm (or worse) as a result of a medical claim denial in the United States, you should promptly find a medical malpractice lawyer in your state who may investigate your health claim denial for you and represent you or your loved one in a medical claim denial case, if appropriate.
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