What is the average health insurance denial rate in Delaware?

Health insurers in Delaware deny approximately 16.3% of ACA marketplace claims, which is 2.8 points below the national average of 19.1%.

How do I appeal a denied insurance claim in Delaware?

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 Delaware Department of Insurance. IMRs are free, decided by independent clinicians, and have high success rates.

Which insurance company denies the most claims in Delaware?

Based on CMS Marketplace Transparency data, the insurers with the highest denial rates in Delaware are Aetna (CVS Health), UnitedHealthcare. See each insurer's full denial report for category-level breakdowns.

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

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

Delaware Insurance Denial Report

The worst health insurers in Delaware
by claim denial rate

Delaware averages a 16.3% denial rate — 2.8 points below the national average. About 52,000 claims are denied annually.

Fight My Denial in Delaware →

16.3%

Delaware avg denial rate

19.1%

National average

52,000

Annual denials in state

>80%

Appeals overturned when filed

Health insurance denials in Delaware

In Delaware, the average health insurance claim denial rate stands at 16.3%, which is notably lower than the national average of 19.1%. This translates to approximately 52,000 claims being denied each year, impacting many residents who rely on health insurance for essential medical services. Understanding this denial rate is crucial for patients, as it highlights the importance of being proactive in managing their health insurance claims and knowing their rights. With this knowledge, patients can better navigate the complexities of the insurance landscape and advocate for their needs effectively.

Patients in Delaware have the right to appeal any denied claims, providing them with a vital tool to challenge decisions made by their insurers. If an internal appeal does not yield a satisfactory outcome, patients can escalate their case to the Delaware Department of Insurance, the state’s regulatory body overseeing insurance practices. This process empowers patients to seek a fair resolution and ensures that their voices are heard in the face of denial. By understanding their rights and the available resources, Delaware residents can take charge of their health insurance journeys.

Worst insurers in Delaware by denial rate

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

Aetna (CVS Health)

17.2% denial rate

Aetna denies 17.2% of claims — 1.9 points below the national average. Their appeal overturn rate is 65%.

GLP-1 Medications: 28% deniedSpecialty Medications: 22% deniedMental Health: 18% denied

Full Aetna 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 Delaware insurance patient

Delaware offers specific patient protections that empower individuals facing health insurance claim denials. Patients have the right to an internal appeal, allowing them to contest the insurer's decision directly. If the internal appeal is unsuccessful, they can request an external Independent Medical Review, which provides an unbiased assessment of the claim. The Delaware Department of Insurance oversees these processes, ensuring compliance with state regulations. Filing a complaint with the department is free of charge and can serve as a powerful tool to pressure insurers into reconsidering their denial decisions.

Delaware Department of Insurance
https://insurance.delaware.gov

Start My Delaware Appeal →

How to appeal a denial in Delaware

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 Delaware 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 Delaware Department 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 Delawareby claim denial rate