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.