There is no public, all-market comparison proving that UnitedHealthcare denies more post-service claims than every other insurer. The latest comparable figures reviewed here cover 2024 ACA Marketplace claims on HealthCare.gov; they show substantial variation among insurers, but do not establish a directly comparable UnitedHealthcare-wide rate. Separate data show UnitedHealthcare denial rates for certain prior-authorization requests, which are decisions about care before it is provided—not the same thing as denying a claim afterward.
What does “claim denial” mean in these comparisons?
A post-service claim is submitted after a provider has delivered care. A prior-authorization request asks an insurer to approve a service before it happens. The two measures have different timing, populations, and denominators, so a prior-authorization denial rate cannot be used as an insurer’s overall claim-denial rate.
That distinction matters for the headline. A 2024 analysis by KFF of ACA Marketplace claims can support comparisons within that market. KFF’s separate analyses of Medicare Advantage, Medicaid managed care, and ACA Marketplace prior authorization address requests for approval, not a universal ranking of post-service claims.
What do the latest comparable ACA Marketplace claim figures show?
KFF’s 2026 analysis of 2024 CMS transparency data covers qualified health plans sold on HealthCare.gov. It includes medical and prescription-drug claims. It does not cover every employer plan, state-based marketplace, Medicaid plan, or Medicare Advantage plan.
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| 2024 HealthCare.gov measure | Reported result | What it means |
|---|---|---|
| In-network claims | 19% denied | Marketwide rate in KFF’s analysis; similar to 2023. |
| Out-of-network claims | 37% denied | Separate rate for out-of-network claims. |
| Combined claims | 20% denied | Overall rate across the claims in the analysis. |
| Insurer and state variation | In-network rates ranged from 3% to 36% | The rate differed by reporting insurer and state. |
| High-volume parent companies | 19% average in-network rate; 8% at Elevance Health and 25% at Oscar Health | Comparison is limited to parent companies receiving more than five million claims in HealthCare.gov states. State-specific Blue Cross and Blue Shield companies are listed separately because they operate independently. |
| Reported claim volume | About 496 million claims; approximately 85 million in-network claims ultimately denied | Insurers reported that 91% of claims were in-network. |
These figures show that denial rates vary, but they do not place UnitedHealthcare in a comprehensive national post-service ranking. The analyzed population is specific to HealthCare.gov plans, and the high-volume comparison identifies Elevance and Oscar at the ends of its reported range without providing a universal ranking of all insurers and products.
The rate also has a defined scope: claims initially denied and later resubmitted and paid are excluded. The data therefore should not be read as a complete account of every initial payment decision or as a measure of how many people ultimately went without care.
What do the UnitedHealthcare prior-authorization figures say?
KFF’s 2026 analysis of publicly available insurer information for 2025 reports UnitedHealthcare denial rates for standard, non-urgent prior-authorization requests in three markets. These are not post-service claim rates, and the markets should not be combined into one company-wide percentage.
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| Market | UnitedHealthcare standard prior-authorization requests denied |
|---|---|
| Medicare Advantage | 17% |
| Medicaid managed care | 11% |
| ACA Marketplace | 21% |
The same KFF analysis reports that 67% of appealed standard prior-authorization denials were overturned in Medicare Advantage, 47% in Medicaid managed care, and 43% in the ACA Marketplace. Those are market-level aggregates, not UnitedHealthcare-specific appeal results. KFF cautions that markets differ and that the same insurer can have different denial shares across them.
A separate KFF analysis of 2024 Medicare Advantage data counted 4.1 million prior-authorization requests that were fully or partially denied, a 7.7% denial rate. Of those denied requests, 11.5% were appealed, and 80.7% of appeals were partially or fully overturned. The reversal figure applies only to the subset appealed; it does not mean that most initial denials across all requests were reversed. Prior authorization may delay care while the request is being resolved.
KFF also notes a limitation in the Medicare Advantage data: CMS does not report the figures by service type or plan type in a way that lets consumers use them to choose a plan.
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How much can appeal data tell patients?
For HealthCare.gov claims, fewer than 1% of denied claims were appealed in 2024, according to KFF. Among those appeals, 66% upheld the initial denial. The appeal outcome therefore describes a small, self-selected subset of denials, not the likelihood that any denied claim would be upheld or reversed if challenged.
Likewise, a high overturn rate among appealed prior-authorization requests should be read alongside the share appealed. It can show that some denials change on review, but it does not reveal how many people never appealed, why they did not, or what happened to care during the process.
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What do denial reasons—and other comparisons—leave out?
For in-network HealthCare.gov denials, the limited reason categories insurers reported were 36% “Other,” 25% administrative, 9% lack of prior authorization or referral, and 5% lack of medical necessity. KFF says insurers do not report what types of services were denied. The categories are incomplete, so they cannot explain the circumstances behind every denial or establish which kinds of care were most affected.
A 2025 survey by the American Medical Rehabilitation Providers Association found that participating inpatient rehabilitation facilities reported UnitedHealthcare initially denied 66.3% of their prior-authorization requests during July and August 2024. That finding is specific to the participating sites and this service setting; it is not a national insurer rate.
A 2026 report by Democrats on the U.S. House Committee on Education and the Workforce cites a separate, privately sourced 2023 prescription-drug-benefit analysis reporting denial rates of 23% for UnitedHealthcare, 24% for Aetna, and 25% for Cigna. Those figures concern prescription-drug benefits, not all medical claims, and the committee report is a secondary source for the private analysis. They cannot fill the gap in a comprehensive post-service comparison.
The Forbes article that popularized the headline was published in December 2024 and updated in March 2025. Its description of an estimated one-third of claims refused was tied to the data then available and its scope; it should not be treated as a current all-market finding. The later KFF Marketplace analysis reports a different, specifically defined 2024 measure.
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The available evidence does not establish that broad claim. For post-service ACA Marketplace claims, public data show a 2024 marketwide rate and meaningful variation, but not a directly comparable, all-market UnitedHealthcare ranking. For prior authorization, UnitedHealthcare has reported denial rates in several markets, but those rates concern pre-service requests and cannot answer how its overall post-service claim denial rate compares.
For a fair comparison, keep the market, year, decision type, and denominator the same. A HealthCare.gov claim rate should be compared with another HealthCare.gov claim rate—not with a Medicare Advantage authorization rate, a provider survey, or a prescription-drug-benefit estimate.
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