The range of health insurance claim denials varies by insurer, state, and type of claim. In 2023, the average denial rate for in-network claims on HealthCare.gov was 19%, but ranged from 1% to 54%.
Denial rates by insurer
- In 2023, some insurers denied as much as 37% of out-of-network claims
- In 2021, some insurers denied as much as 49% of in-network claims
Denial rates by state Denial rates vary by state.
Denial rates by type of claim
- In 2023, insurers denied 19% of in-network claims and 37% of out-of-network claims
Common reasons for denial
- Missing or inaccurate data
- Inaccurate or incomplete patient information
- Lack of prior authorization or referral
- Excluded service
- Administrative reasons
- Lack of medical necessity
Impact of denials
- Denials can result in billions of dollars in lost or delayed reimbursements
- Denials can impact a hospital's financial viability
- Patient harm for delayed treatment.
