The U.S. health insurance industry is a gatekeeper to the $2.3 trillion private health care system. Good at collecting premiums. Good at denying claims. Denied patients can become frustrated, angry and indebted.
“The business model for insurance is don’t pay,” said Anderson, 67, of Centerville, Ohio: PBS NewsHour. UnitedHealthcare CEO shooting opens floodgates of Americans venting insurance frustrations
JAMA. Denial—Artificial Intelligence Tools and Health Insurance Coverage Decisions. JAMA Forum March 7, 2024
Claim denial rates by insurance company
Company | Claim Denials and Profit | |
|---|---|---|
 | UnitedHealthcare | 32% Denials. $22 Billion Profit (2023) |
 | Medica | 27% Denials |
 | Anthem | 23% Denials. $8.7 Billion Profit (2023) |
 | Aetna | 20% Denials $8.3 Billion Profit (2023, CVS) |
 | CareSource | 20% Denials (non-profit) |
 | Molina | 19% Denials. $1.7 Billion Profit (2023) |
 | Cigna | 18% Denials. $6.9 Billion Profit (2023) |
 | BCBS | 17% Denials (non-profit) |
 | Ambetter | 14% Denials $2.7 Billion Profit (2023) |
 | Oscar Health | 12% Denials $271 Million Loss (2023) |
 | Kaiser Permanente | 7% Denials (non-profit) |
Learn more
- How UnitedHealthcare and other insurers use AI to deny claims – Quartz
- Refusal of Recovery- How Medicare Advantage Insurers Have Denied Patients Access to Post-AcuteCare – US Congress Report
- No one knows how often health insurers deny claims. Here’s why – Quartz
- UnitedHealthcare accused of relying on AI algorithms to deny Medicare Advantage claims – FOX Business
- Killing of insurance CEO reveals simmering anger at US health system – BBC News
- Inside the shady world of health insurers — and the 1.2 seconds it takes them to deny claims – The Telegraph
- Healthcare claim denial statistics: State of Claims Report 2024 – Experian Health
- Analysis: Health insurance claim denials are on the rise, to the detriment of patients – PBS News
- Lack of Insurance to Blame for Almost 45,000 Deaths: Study – HealthDay News
- The Only Way to Fix U.S. Health Care. [Medicare For All] The evidence confirms what our patients regard as common sense: copays and deductibles cause people to skip needed care and hence suffer poorer health, and even mortal consequences – Physicians for a National Health Program (PNHP)
25 million Americans with no health insurance (7.5% of population, may be served in hospital emergency room)
