Health insurance · CMS Transparency in Coverage
Health insurers ranked by claim denial rate
Which health insurers deny the most marketplace claims, measured directly from CMS Transparency-in-Coverage filings, not estimates.
- 134
- Insurers ranked
- 21%
- Avg claims denied
- 64%
- Highest denial
According to the U.S. Centers for Medicare & Medicaid Services Transparency in Coverage Public Use File (PY2025, published March 2026), PlainInsurer analyzed more than 10,000 marketplace claims per insurer across the United States to rank health carriers by claim-denial rate. See our methodology for the full computation.
The headline
Across 134 health insurers with reportable volume, AmeriHealth Caritas Florida, Inc. denies the most marketplace claims (63.8%), while Avera Health Plans, Inc. denies the fewest (2.4%) - a gap of 61 points.
- 64%
- highest (AmeriHealth Caritas Florida)
- 21%
- volume-weighted average
- 2%
- lowest (Avera Health Plans)
- 134
- insurers ranked
Denial rate reflects plan design and risk pool, Medicaid managed-care and narrow-network plans route more claims through utilization review, so high denial volume is not by itself proof of unfair practice.
Highest claim-denial rates
Top 12 health insurers by share of marketplace claims denied (≥10,000 claims on file)
- AmeriHealth Caritas Florid
AmeriHealth Caritas Florida, Inc.: 63.8% denied (23,787 of 37,309 claims, 1 states)
63.8 % of claims denied
- CareSource North Carolina
CareSource North Carolina Co.: 45.7% denied (4,891 of 10,705 claims, 1 states)
45.7 % of claims denied
- UnitedHealthcare Community
UnitedHealthcare Community Plan, Inc.: 45.5% denied (117,736 of 258,752 claims, 1 states)
45.5 % of claims denied
- Select Health of South Car
Select Health of South Carolina: 45.5% denied (34,455 of 75,741 claims, 1 states)
45.5 % of claims denied
- UnitedHealthcare of Ohio
UnitedHealthcare of Ohio, Inc.: 43.5% denied (194,892 of 448,360 claims, 1 states)
43.5 % of claims denied
- UnitedHealthcare of Illino
UnitedHealthcare of Illinois, Inc.: 43.1% denied (249,677 of 579,960 claims, 1 states)
43.1 % of claims denied
- AmeriHealth Caritas North
AmeriHealth Caritas North Carolina, Inc.: 43.0% denied (106,857 of 248,740 claims, 1 states)
43 % of claims denied
- UnitedHealthcare of Arizon
UnitedHealthcare of Arizona, Inc.: 41.8% denied (782,383 of 1,873,819 claims, 1 states)
41.8 % of claims denied
- UnitedHealthcare
UnitedHealthcare Insurance Company: 41.4% denied (1,477,609 of 3,567,126 claims, 5 states)
41.4 % of claims denied
- UnitedHealthcare of Oklaho
UnitedHealthcare of Oklahoma, Inc.: 40.3% denied (72,747 of 180,308 claims, 1 states)
40.3 % of claims denied
- Blue Cross and Blue Shield
Blue Cross and Blue Shield of Montana: 38.7% denied (98,238 of 253,794 claims, 1 states)
38.7 % of claims denied
- UnitedHealthcare of Texas
UnitedHealthcare of Texas, Inc.: 38.3% denied (2,205,234 of 5,751,304 claims, 1 states)
38.3 % of claims denied
What this shows These carriers deny the largest share of marketplace claims in the CMS data. Many are Medicaid managed-care organizations, whose product design routes more claims through prior authorization.
Volume vs. denial rate
Each bubble is an insurer, placed by how many marketplace claims it handles and what share it denies. The largest carriers in the top band deny the most claims at scale.
Marketplace claims handled vs % denied, CMS Transparency in Coverage (PY2025)
134 health insurers ranked by claim-denial rate (showing top 50)
What to do with this
A high denial rate is a reason to check a plan's appeal record before you enrol.
- Look up your prospective carrier's full profile and per-state denial rate. Browse insurers
- Denied a claim? Follow the internal and external appeal process. Appeal a denial
- Understand why denial rates vary so much between plans. Read the guide
Verify a plan's current standing with your state insurance department and review its Summary of Benefits and Coverage before any decision. Informational only, not insurance advice.
Source: CMS Transparency in Coverage PUF PY2025. Grades are peer-relative composites of complaint index, denial rate, and prior-authorization data, they do not reflect financial strength. Not affiliated with NAIC or CMS.