Becker's Healthcare January 27, 2025
Insurers on the ACA marketplace denied around one in five in-network claims in 2023, according to a report from KFF published Jan. 27.
Plans sold on the federal ACA marketplace are required to report transparency data, including claim denial rates. Plans on state marketplaces do not have the same requirements, according to KFF.
In 2023, ACA insurers denied 19% of in-network claims. Denial rates were slightly higher in 2023 than in 2022, when ACA insurers denied 16% of claims.
Among insurers with more than 5 million ACA claims in 2023, Blue Cross Blue Shield of Alabama had the highest denial rate, at 35%, according to KFF.
Here are the insurers...
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