Does UnitedHealthcare have the most denied claims?


Editorial team Published on

UnitedHealthcare has previously recorded some of the highest denial rates in specific public reports, but calling it the absolute highest across all insurance categories is misleading.

What the Data Shows

  • ACA Marketplace Plans: In federal data covering individual ACA marketplace plans for 2023, UnitedHealthcare (UHC) did rank among the highest deniers, rejecting roughly 33% of in-network claims. However, newer 2024 data shows UHC's marketplace denial rate dropped to 20%, placing other providers like Oscar Health (25.3%) higher.
  • Medicare Advantage: For Medicare Advantage prior authorization requests, UHC has faced scrutiny for high denial rates (around 12.8%), which is elevated compared to some major competitors.
  • The Company's Stance: UnitedHealthcare UnitedHealthcare states that it approves and pays roughly 90% of claims initially, with final approval rates climbing to 98% for eligible, timely, and complete submissions. Company executives have also argued that marketplace-specific datasets represent a tiny fraction (about 2%) of their total claims volume and do not reflect their entire business.
  • Data Limitations: Health policy experts emphasize that comprehensive, publicly available data covering all types of private, employer-sponsored health plans does not exist, making cross-company comparisons partial and heavily dependent on which subset of data (like ACA exchanges or Medicare) is being analyzed.