Denial rates can vary significantly between different insurance companies and even different plans within the same company. It’s essential to remember that claim denial rates by insurance company are just estimates and can vary significantly. The common range quoted by experts for claim denil is 10% to 20%, suggesting that, on average, 10% to 20% of claims are denied by insurance companies.
Factors Affecting Denial Rates:
- Plan Type: Different types of insurance plans (e.g., HMO, PPO, EPO) may have varying denial rates.
- Provider Network: Claims submitted to out-of-network providers are more likely to be denied or partially paid.
- Claim Accuracy and Completeness: Incomplete or inaccurate claims are often denied.
- Insurance Company Policies: Each insurance company has its own specific policies and procedures for processing claims.
General Tips to Minimize Claim Denials:
- Choose a Reputable Insurer: Research companies, read reviews, and consider customer satisfaction ratings.
- Understand Your Policy: Familiarize yourself with your policy’s terms, conditions, and exclusions.
- Submit Accurate and Complete Claims: Ensure all necessary documentation is included.
- Follow Up: Regularly check the status of your claim and follow up if necessary.
- Appeal Denials: If your claim is denied, understand the appeals process and file a timely appeal.
Table of some insurance companies with high claim denial rates
| Insurance Company | Claim Denial Rate |
|---|---|
| UnitedHealthcare | 32% |
| Medica | 27% |
| Anthem | 23% |
| Aetna | 20% |
| CareSource | 20% |
| Cigna | 19% |
| Humana | 18% |
| Molina Healthcare | 17% |
| Blue Cross Blue Shield | 16% |
| Centene | 15% |
| Health Net | 14% |
| WellCare | 13% |
| Oscar Health | 12% |
| Bright Health | 11% |
| Kaiser Permanente | 7% |
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- Financial Strength: We use data from independent financial ratings (such as A.M. Best or S&P) which indicate the carrier’s ability to pay out claims reliably and on time.
- Customer Experience: We analyze user reviews and complaint indexes to gauge policyholders’ satisfaction during the claim process.