What is the average health insurance denial rate in Illinois?

Health insurers in Illinois deny approximately 19.1% of ACA marketplace claims, which is 0.0 points below the national average of 19.1%.

How do I appeal a denied insurance claim in Illinois?

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

Which insurance company denies the most claims in Illinois?

Based on CMS Marketplace Transparency data, the insurers with the highest denial rates in Illinois are Cigna Healthcare, Ambetter from Centene, Molina Healthcare. See each insurer's full denial report for category-level breakdowns.

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

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

Illinois Insurance Denial Report

The worst health insurers in Illinois
by claim denial rate

Illinois averages a 19.1% denial rate — 0.0 points below the national average. About 590,000 claims are denied annually.

Fight My Denial in Illinois →

19.1%

Illinois avg denial rate

19.1%

National average

590,000

Annual denials in state

>80%

Appeals overturned when filed

Health insurance denials in Illinois

In Illinois, the average health insurance claim denial rate stands at 19.1%, mirroring the national average. This statistic translates to approximately 590,000 denied claims each year, highlighting a significant challenge for patients seeking necessary medical care. Such a high rate of denial can lead to financial stress and hinder access to vital health services, underscoring the importance of understanding one's rights and options in navigating the insurance landscape.

Patients in Illinois should be aware that they have the right to appeal denied claims. The appeals process is a crucial step in advocating for oneself and can lead to successful overturns of initial decisions. If internal appeals are unsuccessful, patients can escalate their cases to the Illinois Department of Insurance, the regulatory body overseeing insurance practices in the state. This escalation ensures that patients have a channel to seek resolution and hold insurers accountable for their decisions.

Worst insurers in Illinois by denial rate

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

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 →

Ambetter from Centene

21.3% denial rate

Ambetter denies 21.3% of claims — 2.2 points above the national average. Their appeal overturn rate is 53%.

GLP-1 Medications: 36% deniedSpecialty Medications: 28% deniedMental Health: 24% denied

Full Ambetter denial report →

Molina Healthcare

22.4% denial rate

Molina denies 22.4% of claims — 3.3 points above the national average. Their appeal overturn rate is 55%.

GLP-1 Medications: 38% deniedSpecialty Medications: 30% deniedMental Health: 25% denied

Full Molina denial report →

Your rights as a Illinois insurance patient

In Illinois, patients are empowered by specific protections that enhance their rights in the insurance appeal process. They have the right to an internal appeal, allowing them to contest a denial directly with their insurer. If the internal appeal does not yield a favorable outcome, patients can request an external Independent Medical Review, offering an unbiased evaluation of their claim. The Illinois Department of Insurance facilitates these processes, and filing a complaint with them is free, serving as a valuable tool to pressure insurers into reconsidering their decisions.

Illinois Department of Insurance
https://insurance.illinois.gov

Start My Illinois Appeal →

How to appeal a denial in Illinois

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 Illinois 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 Illinois 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 Illinoisby claim denial rate