Which Health Insurers Deny the Most Claims?

June 19, 2025

You pay your health insurance premiums on time, follow the plan rules, and trust your insurer to cover the care you were promised. So when a claim is unexpectedly denied, it can leave you angry, confused, and concerned about how to cover the bill. These feelings are understandable, and you’re not alone. Every year, millions of insured Americans face similar denials of coverage.

However, there is some good news: a denial is not necessarily the final word. You have the right to challenge your insurance company’s decision, and there is a structured process to do so.

Whether your claim was denied due to a coding error, lack of prior authorization, or an insurer’s internal policy, you may be able to get it reversed.

Understanding your rights, knowing the process, and getting the right help can make all the difference.

Health Insurance Claim Denials Are More Common Than You Think

Insurance companies deny claims for many reasons—some legitimate, others not. Unfortunately, denials have become so widespread that they often go unchallenged, simply because policyholders are unaware of their rights or feel too overwhelmed to fight back. Often, policyholders raise the question: Which health insurers deny the most claims?

What the Numbers Show: Denial Rates Are Alarmingly High

A study conducted by the Kaiser Family Foundation (KFF) reveals some sobering statistics. According to their research:

• Roughly 6 in 10 insured adults experienced problems using their health insurance.
• These problems included denied claims, network limitations, and prior authorization issues.
• Private insurers had higher denial rates than public plans like Medicare and Medicaid.
• Patients with frequent doctor visits were more likely to see claims denied.
• Members of the LGBTQ+ community faced disproportionately high denial rates.
• And perhaps most troubling: most people who had a claim denied never appealed it, often because they didn’t know how, or that they even could.

These statistics make one thing very clear: Claim denials are systemic, not personal. You are not alone, and you are not powerless.

Addressing Denials Appropriately

The First Step: Read and Understand Your Explanation of Benefits (EOB)

One of the most important tools you have as a policyholder is your Explanation of Benefits (EOB). This document outlines what your insurer paid (or didn’t pay) after receiving a claim from your healthcare provider.

Here’s what you’ll typically find on an EOB:

• Patient Name
• Date of Service
• Provider Information
• Claim Number
• Insurance Policy or ID Number
• Description of Services
• Billed Charges
• Allowed Amount
• Amount Paid by Insurance
• Amount Not Covered
• Your Financial Responsibility (co-pay, coinsurance, or deductible).

Take the time to review your EOB carefully. If something seems incorrect—such as services being marked as out-of-network when you know they were not—contact your insurance company representative immediately. A simple coding error or administrative mistake may be to blame.

Keep all EOBs, bills, and medical records organized and in one place. These documents may be critical if you choose to file an appeal.

Denied? Don’t Panic—Appeal

Once you receive a denial, the next step is to appeal through your insurance company’s official process. Most of these organizations are required by law to provide clear instructions for how to appeal a denied claim.

Follow this appeal process exactly.

This step is vital. Every insurance company has specific requirements for appeals. If you fail to follow their process—by missing a deadline, leaving out required documentation, or using the wrong submission method—your appeal may be dismissed before it’s even reviewed.

Most health insurance companies post this information on their websites, including:

• The forms you need to complete
• Whether you can submit online, by fax, or by mail
• Deadlines for appeal submissions (typically within 180 days of the denial).

In all cases, it’s best to submit your appeal in writing, even if your carrier allows phone appeals. Keep a copy of everything you send and confirm your receipt if possible.

If your first-level appeal is denied, you may be entitled to an external review by an independent third party under federal law, especially for plans governed by the Affordable Care Act (ACA).

What You’re Up Against: The Insurance Company’s Incentives

Unfortunately, health insurers are often motivated to deny claims to maximize profits. The fewer claims they pay out, the more they save. Many insurers rely on the fact that most policyholders will not appeal.

Worse yet, some denials may be in bad faith, meaning the insurer had no reasonable basis for denying your claim and did so in a way that violated your rights under state insurance laws. If your insurance company acts inappropriately, you may be entitled to additional bad faith damages.

You Don’t Have to Fight Alone

When a health insurance claim is denied, the burden often falls on the patient to foot the bill. This can mean thousands—or even tens of thousands—of dollars in unexpected expenses. But you don’t have to accept this outcome. You have rights. You have options. And with the right legal help, you can level the playing field.  This is where an experienced denied health insurance claims attorney can help. The advice and counsel they provide can result in a decision reversal, payment of your claim, and even compensation for damages.

Don’t Let a Denied Claim Derail Your Health or Your Finances

Contact Doug Terry, an Experienced Health Insurance Lawyer

At Doug Terry Law, we’ve seen firsthand how insurance companies try to avoid paying valid claims—and we know how to fight back. Based in Oklahoma, Doug Terry is a former insurance defense attorney who now uses that insider knowledge to advocate for consumers.

Doug Terry has:

• Decades of experience fighting denied health insurance claims
• A track record of success challenging wrongful denials
• A deep understanding of both state law and insurer practices
• A commitment to transparency, responsiveness, and client care.

Mr. Terry and his team take the time to analyze EOBs, policy documents, and correspondence, helping clients build strong cases for appeal. If the insurance company acted in bad faith, they can take legal action on behalf of their clients.

Don’t Wait -Take Action Today

If your health insurance claim has been unfairly denied, call Doug Terry Law today at 405-463-6362 for a free consultation. We’ll review your situation, explain your options, and help you decide how to move forward.

Your health and financial stability are too important to leave in the hands of an insurance company. Let us help you resolve your denied health insurance claim.