Insurer Denial Rates
insurer_denial_ratesWhich health insurers deny the most claims — US marketplace issuers ranked by the share of in-network claims they denied, for plan year 2026. Answers "what percentage of claims does my insurance company deny", "which insurer denies the most", "how often does deny claims", and comparisons between insurers in a state. Returns each issuer with claims received, claims denied, the denial rate as a percentage, and how many marketplace plans it offers. Filter by state (two-letter code) or by market — medical plans (Individual QHP), standalone dental (Individual SADP, which denies at much higher rates than medical), or small-group SHOP; the market filter selects which ISSUERS to include, since CMS publishes these counts per issuer rather than per market. Sourced from the CMS Transparency in Coverage Public Use File, which insurers report into under federal rule; covers HealthCare.gov states only, so issuers on state-run exchanges such as California and New York are not present.
Input Schema
| Name | Required | Description | Default |
|---|---|---|---|
| limit | No | How many issuers to return (default 20, max 200). | |
| order | No | "highest" (default) ranks the biggest deniers first; "lowest" ranks the smallest. | |
| state | No | Two-letter US state code to filter by, e.g. "TX", "FL". Omit for all states. | |
| market | No | Restrict to issuers participating in a market: "medical" / "QHP", "dental" / "SADP" for standalone dental, or "SHOP" for small-group. Selects issuers; it does not split an issuer's claim counts, which CMS reports per issuer. Omit for all three. |