Health Insurance Claim Denials on the Rise (2026)

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Recent reporting outlines an increase in health insurance claim denials by insurers, with many patients being denied coverage for some of the most basic medical services. Unfortunately, studies show that many policyholders forego fighting these denials and simply pay the bills themselves, potentially leaving money they were owed on the table.

Why it matters

These denials often have devastating effects on patients and may delay or deny necessary medical treatment, leaving patients without the care they need for their health and well-being. The federal government has not expanded or revised transparency data reporting requirements for claim denials in years, and does not appear to conduct any oversight using data reported by marketplace plans, leaving consumers lacking access to information about how reliably marketplace plan options pay claims.

The details

According to the Kaiser Family Foundation's (KFF) study on healthcare claim denials, 17 percent of in-network claims were denied in 2021, or 17 out of every 100 claims. Insurer denial rates ranged from 2 to 49 percent, depending on the company. The study found that 14 percent of in-network claims were denied because the claim was for an excluded service, 8 percent were a result of a lack of preauthorization or referral, and 2 percent were on medical necessity. Interestingly, insurers classified 77 percent of plan-reported denials as 'all other reasons,' without providing a more detailed explanation.

• In 2021, HealthCare.gov consumers appealed less than two-tenths of 1 percent of denied in-network claims, and insurers upheld over half (59 percent) of denials on appeal.

What they’re saying