What is the average health insurance denial rate in New York?

Health insurers in New York deny approximately 14.1% of ACA marketplace claims, which is 5.0 points below the national average of 19.1%.

How do I appeal a denied insurance claim in New York?

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 New York Department of Financial Services. IMRs are free, decided by independent clinicians, and have high success rates.

Which insurance company denies the most claims in New York?

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

What are my rights if my insurance claim is denied in New York?

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

New York Insurance Denial Report

The worst health insurers in New York
by claim denial rate

New York averages a 14.1% denial rate — 5.0 points below the national average. About 890,000 claims are denied annually.

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14.1%

New York avg denial rate

19.1%

National average

890,000

Annual denials in state

>80%

Appeals overturned when filed

Health insurance denials in New York

In New York, the average health insurance claim denial rate stands at 14.1%, significantly lower than the national average of 19.1%. This translates to approximately 890,000 denials annually, highlighting a substantial issue that affects many residents. While New York's denial rate is more favorable, it still represents a considerable number of individuals who may face challenges in accessing necessary medical care. Understanding this statistic is essential for patients navigating the complexities of health insurance, as it underscores the importance of being proactive in addressing any claim denials they encounter.

Patients in New York have the right to appeal any denied claims, empowering them to advocate for their healthcare needs. If an internal appeal does not yield satisfactory results, individuals can escalate their cases to the New York Department of Financial Services, the regulatory body overseeing insurance practices in the state. This process ensures that patients have a clear pathway to challenge denials and seek the coverage they deserve, reinforcing their rights within the healthcare system.

Worst insurers in New York 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 →

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 →

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 New York insurance patient

New York offers specific patient protections that enhance the appeal process. Patients have the right to an internal appeal of denied claims, as well as the option for an external Independent Medical Review if the internal appeal is unsuccessful. The New York Department of Financial Services oversees these processes, ensuring that patients can file complaints at no cost. This free complaint filing can effectively pressure insurers to reconsider their decisions, providing an essential avenue for patients to assert their rights and secure the medical care they need.

New York Department of Financial Services
https://www.dfs.ny.gov

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How to appeal a denial in New York

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 New York 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 New York Department of Financial Services. 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 New Yorkby claim denial rate