Blue Cross and Blue Shield of Alabama, UnitedHealthcare, Health Care Service Corp. and Molina Healthcare denied more than one-quarter of in-network claims from members with federal health insurance exchange plans in 2023, according to a KFF analysis published Monday.
Health insurers selling marketplace plans in states that use the federal HealthCare.gov enrollment platform rejected 19% of in-network claims on average in 2023, the health policy research organization determined using Centers for Medicare and Medicaid Services data. That's up from 16% in 2022 and matches the share from 2015, the year the exchange coverage debuted. The rate has been steady over time, ranging from a 14% low in 2018 to a 19% high in 2015 and 2023.
Related: Insurers inventing more roadblocks to claims, providers say
Health insurance headaches have grown increasingly vexing to providers, patients and policymakers in recent years. A KFF survey conducted this month found that 55% of people want President Donald Trump and Congress to address claims denials.
Nonprofit Blue Cross and Blue Shield of Alabama turned down 35% of in-network claims in 2023, the highest rate on the federal exchanges. For-profit UnitedHealth Group subsidiary UnitedHealthcare followed at 33%, then nonprofit Blue Cross and Blue Shield licensee Health Care Service Corp. at 29% and for-profit Molina Healthcare at 26%.
For-profit Elevance Health, which sells Anthem Blue Cross Blue Shield plans on the exchanges, for-profit CVS Health subsidiary Aetna, nonprofit BlueCross BlueShield of Tennessee, for-profit Cigna, and nonprofit CareSource also denied a higher-than-average proportion of in-network claims that year, KFF found.