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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.