Insurance Denial Intelligence
49 million claims are denied every year. Less than 1% are appealed. When patients do appeal, 82% of prior auth appeals succeed (AMA, 2024). Research your insurer below.
49M+
Claims denied annually
<1%
Of denials are appealed
82%
Prior auth appeal success rate
Sources: KFF (2024), AMA Prior Authorization Survey (2024), HHS OIG (2018). Rates vary by insurer and claim type.
Insurer Playbooks
Select your insurer to view denial patterns, appeal strategies, and known weaknesses.
UnitedHealthcare
Anthem Blue Cross Blue Shield
Aetna (CVS Health)
Cigna Healthcare
Humana
Kaiser Permanente
Centene / WellCare / Ambetter
Molina Healthcare
Blue Cross Blue Shield Federal Employee Program (FEP)
Highmark Blue Cross Blue Shield
Oscar Health
TRICARE (Military Health)
Independence Blue Cross
CareFirst BlueCross BlueShield
Blue Cross Blue Shield of California (Anthem Blue Cross)
Blue Cross Blue Shield of Illinois
Blue Cross Blue Shield of Texas
Florida Blue (Blue Cross Blue Shield of Florida)
Blue Cross Blue Shield of Michigan
Medicare Fee-for-Service (Traditional Medicare)
CVS Caremark (Pharmacy Benefit Manager)
Express Scripts (Pharmacy Benefit Manager)
OptumRx (Pharmacy Benefit Manager)
Medicaid (State Medicaid Program — Generic Template)
Denial Categories
Common reasons insurers deny claims, and what they mean for your appeal.
Medical Necessity
Service deemed not medically necessary
Experimental/Investigational
Treatment considered experimental
Out of Network
Provider not in plan network
Prior Authorization
Required prior authorization not obtained
Not Covered
Service not covered under plan
Timely Filing
Claim filed past deadline
Duplicate Claim
Claim considered a duplicate
Coding Error
CPT/ICD coding mismatch
Incomplete Documentation
Missing required documentation
Formulary
Drug not on formulary
Step Therapy
Must try other treatments first
Benefit Exclusion
Explicitly excluded by plan
Coordination of Benefits
Other insurance should pay
Administrative
Administrative/procedural issue
Have a denial? Upload it for free analysis.
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Upload Your Denial — FreeThis information is for educational purposes based on publicly available data including CMS reports, state insurance department filings, and published insurer guidelines. It does not constitute legal, medical, or financial advice. Individual results vary. Statistics are industry averages and do not represent Lysco-specific outcomes.