What is the average health insurance denial rate in Colorado?

Health insurers in Colorado deny approximately 17.5% of ACA marketplace claims, which is 1.6 points below the national average of 19.1%.

How do I appeal a denied insurance claim in Colorado?

File a written internal appeal with your insurer within 180 days of the denial. If denied again, escalate to an Independent Medical Review (IMR) with the Colorado Division of Insurance. IMRs are free, decided by independent clinicians, and have high success rates.

Which insurance company denies the most claims in Colorado?

Based on CMS Marketplace Transparency data, the insurers with the highest denial rates in Colorado are Oscar Health, Cigna Healthcare, UnitedHealthcare. See each insurer's full denial report for category-level breakdowns.

What are my rights if my insurance claim is denied in Colorado?

You have the right to a full written explanation of the denial, an internal appeal, and an external Independent Medical Review with the Colorado Division of Insurance. Federal law requires insurers to respond to standard appeals within 30 days and urgent appeals within 72 hours.

Colorado Insurance Denial Report

The worst health insurers in Colorado
by claim denial rate

Colorado averages a 17.5% denial rate — 1.6 points below the national average. About 195,000 claims are denied annually.

Fight My Denial in Colorado →

17.5%

Colorado avg denial rate

19.1%

National average

195,000

Annual denials in state

>80%

Appeals overturned when filed

Health insurance denials in Colorado

In Colorado, the average health insurance claim denial rate stands at 17.5%, which is notably lower than the national average of 19.1%. This statistic translates to approximately 195,000 claim denials annually, highlighting a significant issue that affects many residents. Understanding this denial rate is crucial for patients, as it reflects the challenges they may face when seeking coverage for necessary medical services. With nearly one in five claims being denied, the importance of knowing your rights and options becomes paramount for navigating the healthcare system effectively.

Fortunately, patients in Colorado have the right to appeal denied claims, empowering them to take action against unjust decisions made by insurance companies. If an internal appeal does not yield a satisfactory outcome, patients can escalate their concerns to the Colorado Division of Insurance, the state’s regulatory body. This agency oversees insurance practices and can provide guidance on the appeals process, ensuring that patients have a platform to advocate for their healthcare needs. By understanding these rights, patients can better navigate the complexities of insurance denials and work towards securing the coverage they deserve.

Worst insurers in Colorado by denial rate

Source: CMS Marketplace Transparency Report 2023. In-network ACA marketplace claims only.

Oscar Health

34.6% denial rate

Oscar denies 34.6% of claims — 15.5 points above the national average. Their appeal overturn rate is 58%.

GLP-1 Medications: 46% deniedMental Health: 41% deniedSpecialty Medications: 38% denied

Full Oscar denial report →

Cigna Healthcare

33.1% denial rate

Cigna denies 33.1% of claims — 14.0 points above the national average. Their appeal overturn rate is 61%.

GLP-1 Medications: 44% deniedSpecialty Medications: 40% deniedMental Health: 37% denied

Full Cigna denial report →

UnitedHealthcare

32.5% denial rate

UHC denies 32.5% of claims — 13.4 points above the national average. Their appeal overturn rate is 57%.

Specialty Medications: 43% deniedGLP-1 Medications: 41% deniedMRI / CT Scans: 35% denied

Full UHC denial report →

Your rights as a Colorado insurance patient

In Colorado, patients are afforded specific protections when it comes to health insurance claim denials. They have the right to an internal appeal, allowing them to challenge the insurance company’s decision directly. Additionally, if the internal appeal does not resolve the issue, patients can request an external Independent Medical Review, which provides an impartial assessment of the claim. The Colorado Division of Insurance oversees these processes, ensuring that patients are treated fairly. Filing a complaint with this regulatory body is free and can create pressure on insurers to reconsider their denial, reinforcing the importance of patient advocacy in the healthcare system.

Colorado Division of Insurance
https://doi.colorado.gov

Start My Colorado Appeal →

How to appeal a denial in Colorado

1
Request the denial in writing
Ask your insurer for the specific clinical criteria and coverage policy they used to deny you. They are legally required to provide it within 30 days.
2
File your internal appeal
Send a written appeal to your insurer within 180 days. Cite your doctor's clinical documentation, relevant medical guidelines, and Colorado insurance law. A well-written appeal citing specific laws wins over 80% of the time.
3
Escalate to the state if denied again
If your internal appeal is denied, file an Independent Medical Review (IMR) with the Colorado Division of Insurance. This is free and decided by independent clinicians. Their decision is often binding.
4
Use disputes.health to generate your letter
Our agents generate a clinic-grade appeal letter in under 15 minutes — citing your state's laws, relevant medical guidelines, and your specific situation. We then submit it to your insurer for you.

How to appeal a denial →GLP-1 denial guide →Mental health denial guide →All public resources →

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The worst health insurers in Coloradoby claim denial rate