Which Health Insurance Companies Deny Claims the Most? Arizona Health Insurance Plan Denial Rates
Regardless of industry, denying claims is a fundamental part of the business model of insurance companies. This is no different when it comes to health insurance. While many claims are denied for valid reasons, insurers routinely unjustly deny or delay the value of those claims. When that happens, insurance companies may be acting in bad faith. Below, we analyze Arizona health insurance claims data from the Centers for Medicare and Medicaid Services (CMS). The data is a representative sample and shows non-group qualified health plans (QHPs) offered in Arizoan on HealthCare.gov for the year 2021.
Which Health Insurance Companies Deny claims the most?
Of companies that had claims data available, Oscar Health Plan, Inc. denied claims at the highest rate – over 67 percent of claims were denied. Cigna HealthCare of Arizona, Inc had the lowest rate of denial at just under 12 percent.
Insurer Name | Total Claims Received | Total Claims Denied | Percentage of Claims Denied |
---|---|---|---|
Oscar Health Plan, Inc. | 10388 | 6986 | 67.25 percent |
Health Net of Arizona, Inc. | 1943258 | 527951 | 27.16 percent |
Bright Health Company of Arizona | 666465 | 129389 | 19.41 percent |
Blue Cross and Blue Shield of Arizona, Inc. | 1374409 | 177779 | 12.93 percent |
Cigna HealthCare of Arizona, Inc | 203309 | 24216 | 11.91 percent |
Which Health Insurance Plans See the Most Claims Denied In Arizona?
Below, we list claims, denials, and denial rates for individual health insurance plans in Arizona. Again, these are aggregate totals and do not reflect the reasons that a claim may or may not have been denied.
Insurer Name | Plan ID | Metal Level | Claims Received | Claims Denied | Percent Denied |
---|---|---|---|---|---|
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420001 | Gold | 9619 | 1638 | 17.03 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420002 | Gold | 2447 | 271 | 11.07 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420003 | Gold | 301 | 22 | 7.31 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420006 | Gold | 14302 | 1654 | 11.56 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420007 | Gold | 3284 | 480 | 14.62 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420008 | Silver | 43660 | 5900 | 13.51 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420009 | Silver | 6974 | 692 | 9.92 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420010 | Silver | 2936 | 248 | 8.45 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420013 | Silver | 60936 | 6050 | 9.93 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420014 | Silver | 24767 | 3482 | 14.06 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420015 | Bronze Expanded | 45372 | 6222 | 13.71 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420016 | Bronze Expanded | 9967 | 1199 | 12.03 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420017 | Bronze Expanded | 798 | 41 | 5.14 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420020 | Bronze Expanded | 73866 | 7600 | 10.29 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420021 | Bronze Expanded | 19654 | 2375 | 12.08 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420022 | Bronze Expanded | 28079 | 3591 | 12.79 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420023 | Bronze Expanded | 5759 | 684 | 11.88 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420024 | Bronze Expanded | 548 | 78 | 14.23 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420027 | Bronze Expanded | 63493 | 6284 | 9.90 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420028 | Bronze Expanded | 10852 | 1595 | 14.70 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420037 | Silver | 42747 | 6426 | 15.03 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420038 | Silver | 8521 | 980 | 11.50 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420039 | Silver | 5350 | 634 | 11.85 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420040 | Silver | 104550 | 10856 | 10.38 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420041 | Silver | 32879 | 4151 | 12.63 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420042 | Silver | 27700 | 3109 | 11.22 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420043 | Silver | 84686 | 9371 | 11.07 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420044 | Silver | 2535 | 721 | 28.44 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420045 | Silver | 27238 | 3574 | 13.12 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420046 | Silver | 34371 | 3464 | 10.08 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420047 | Silver | 39603 | 5928 | 14.97 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420048 | Gold | 6848 | 811 | 11.84 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420049 | Gold | 5309 | 663 | 12.49 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420050 | Gold | 379 | 83 | 21.90 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420051 | Gold | 2393 | 520 | 21.73 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420052 | Gold | 4551 | 603 | 13.25 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420053 | Gold | 19070 | 3210 | 16.83 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420054 | Silver | 18936 | 2191 | 11.57 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420055 | Silver | 48699 | 5278 | 10.84 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420056 | Silver | 4500 | 579 | 12.87 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420057 | Silver | 14910 | 1631 | 10.94 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420058 | Silver | 26423 | 2592 | 9.81 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420059 | Silver | 21821 | 3639 | 16.68 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420060 | Bronze Expanded | 21539 | 2150 | 9.98 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420061 | Bronze Expanded | 46024 | 4922 | 10.69 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420062 | Bronze Expanded | 3743 | 418 | 11.17 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420063 | Bronze Expanded | 12100 | 1634 | 13.50 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420064 | Bronze Expanded | 19864 | 2389 | 12.03 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420065 | Bronze Expanded | 32398 | 5376 | 16.59 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420066 | Bronze Expanded | 23319 | 3078 | 13.20 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420067 | Bronze Expanded | 34690 | 3499 | 10.09 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420068 | Bronze Expanded | 4737 | 479 | 10.11 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420069 | Bronze Expanded | 12981 | 1650 | 12.71 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420070 | Bronze Expanded | 17212 | 1762 | 10.24 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420071 | Bronze Expanded | 25778 | 4052 | 15.72 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420078 | Gold | 16178 | 3806 | 23.53 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420079 | Silver | 20811 | 4879 | 23.44 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420080 | Bronze Expanded | 17567 | 4683 | 26.66 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420081 | Silver | 30313 | 7081 | 23.36 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420082 | Silver | 12866 | 3142 | 24.42 |
Blue Cross and Blue Shield of Arizona, Inc. | 53901AZ1420083 | Silver | 10655 | 1658 | 15.56 |
Health Net of Arizona, Inc. | 91450AZ0080035 | Silver | 311871 | 80376 | 25.77 |
Health Net of Arizona, Inc. | 91450AZ0080036 | Bronze | 68705 | 17042 | 24.80 |
Health Net of Arizona, Inc. | 91450AZ0080037 | Bronze Expanded | 132288 | 33727 | 25.50 |
Health Net of Arizona, Inc. | 91450AZ0080044 | Silver | 404213 | 114416 | 28.31 |
Health Net of Arizona, Inc. | 91450AZ0080052 | Silver | 148104 | 44169 | 29.82 |
Health Net of Arizona, Inc. | 91450AZ0080059 | Gold | 73773 | 22224 | 30.12 |
Health Net of Arizona, Inc. | 91450AZ0180035 | Silver | 18512 | 5890 | 31.82 |
Health Net of Arizona, Inc. | 91450AZ0180036 | Bronze | 9232 | 2933 | 31.77 |
Health Net of Arizona, Inc. | 91450AZ0180044 | Silver | 39532 | 11784 | 29.81 |
Health Net of Arizona, Inc. | 91450AZ0180059 | Gold | 9016 | 3314 | 36.76 |
Bright Health Company of Arizona | 87247AZ0010001 | Gold | 4285 | 928 | 21.66 |
Bright Health Company of Arizona | 87247AZ0010002 | Silver | 70747 | 15422 | 21.80 |
Bright Health Company of Arizona | 87247AZ0010003 | Silver | 59630 | 13638 | 22.87 |
Bright Health Company of Arizona | 87247AZ0010006 | Bronze Expanded | 122936 | 24948 | 20.29 |
Bright Health Company of Arizona | 87247AZ0010007 | Bronze Expanded | 47575 | 11445 | 24.06 |
Bright Health Company of Arizona | 87247AZ0010008 | Bronze Expanded | 12229 | 2573 | 21.04 |
Bright Health Company of Arizona | 87247AZ0010009 | Bronze Expanded | 52413 | 10259 | 19.57 |
Bright Health Company of Arizona | 87247AZ0010010 | Catastrophic | 1620 | 315 | 19.44 |
Bright Health Company of Arizona | 87247AZ0010011 | Silver | 110107 | 22818 | 20.72 |
Bright Health Company of Arizona | 87247AZ0010012 | Silver | 80714 | 4172 | 5.17 |
Bright Health Company of Arizona | 87247AZ0010020 | Catastrophic | 142 | 20 | 14.08 |
Bright Health Company of Arizona | 87247AZ0010021 | Gold | 677 | 141 | 20.83 |
Bright Health Company of Arizona | 87247AZ0010022 | Silver | 10106 | 2234 | 22.11 |
Bright Health Company of Arizona | 87247AZ0010023 | Silver | 6799 | 1510 | 22.21 |
Bright Health Company of Arizona | 87247AZ0010026 | Bronze Expanded | 16918 | 3974 | 23.49 |
Bright Health Company of Arizona | 87247AZ0010027 | Bronze Expanded | 4914 | 1007 | 20.49 |
Bright Health Company of Arizona | 87247AZ0010028 | Bronze Expanded | 663 | 215 | 32.43 |
Bright Health Company of Arizona | 87247AZ0010029 | Bronze Expanded | 9048 | 1959 | 21.65 |
Bright Health Company of Arizona | 87247AZ0010031 | Silver | 21500 | 4449 | 20.69 |
Bright Health Company of Arizona | 87247AZ0010032 | Silver | 16037 | 3411 | 21.27 |
Oscar Health Plan, Inc. | 13877AZ0070003 | Bronze Expanded | 1397 | 897 | 64.21 |
Oscar Health Plan, Inc. | 13877AZ0070005 | Bronze Expanded | 3457 | 2269 | 65.63 |
Oscar Health Plan, Inc. | 13877AZ0070006 | Silver | 532 | 350 | 65.79 |
Oscar Health Plan, Inc. | 13877AZ0070008 | Silver | 439 | 244 | 55.58 |
Oscar Health Plan, Inc. | 13877AZ0070011 | Catastrophic | 175 | 94 | 53.71 |
Oscar Health Plan, Inc. | 13877AZ0070013 | Gold | 855 | 442 | 51.70 |
Cigna HealthCare of Arizona, Inc | 97667AZ0110013 | Silver | 69168 | 7950 | 11.49 |
Cigna HealthCare of Arizona, Inc | 97667AZ0110014 | Bronze Expanded | 27262 | 3399 | 12.47 |
Cigna HealthCare of Arizona, Inc | 97667AZ0110016 | Bronze Expanded | 37721 | 4245 | 11.25 |
Cigna HealthCare of Arizona, Inc | 97667AZ0110018 | Silver | 60964 | 7617 | 12.49 |
Cigna HealthCare of Arizona, Inc | 97667AZ0110019 | Gold | 8194 | 1005 | 12.27 |
Info on Claims Denial Data
The tables above reflect transparency data released by the Centers for Medicare and Medicaid Services (CMS) on claims denials and appeals for non-group qualified health plans (QHPs) offered on HealthCare.gov.
Data on claims denials reflects issuer and plan level data, for services rendered during the calendar year January 1 to December 31. The data provided is an aggregate number for plans sold by an issuer on the FFEs, including FFEs where States perform plan management functions, and SBE-FPs only. The issuer level data includes claims denials for all reasons. Issuers could deny claims for various reasons, and this information simply provides a raw number. The plan level data includes claims denials broken down into various categories. Claims denials are not necessarily indicative of issuer strength or plan quality.