What is the average health insurance denial rate in Washington?

Health insurers in Washington deny approximately 15.8% of ACA marketplace claims, which is 3.3 points below the national average of 19.1%.

How do I appeal a denied insurance claim in Washington?

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 Washington State Office of the Insurance Commissioner. IMRs are free, decided by independent clinicians, and have high success rates.

Which insurance company denies the most claims in Washington?

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

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

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

Washington Insurance Denial Report

The worst health insurers in Washington
by claim denial rate

Washington averages a 15.8% denial rate — 3.3 points below the national average. About 320,000 claims are denied annually.

Fight My Denial in Washington →

15.8%

Washington avg denial rate

19.1%

National average

320,000

Annual denials in state

>80%

Appeals overturned when filed

Health insurance denials in Washington

In Washington, the average health insurance claim denial rate stands at 15.8%, which is notably lower than the national average of 19.1%. This means that approximately 320,000 claims are denied each year, affecting countless patients who rely on their insurance coverage for essential medical services. Understanding this denial rate is crucial for Washington residents, as it highlights the importance of being proactive in managing health insurance claims and navigating the complexities of the system. With a significant number of claims denied annually, it is vital for patients to be informed and prepared to take action when faced with a denial.

Patients in Washington have the right to appeal denied claims, empowering them to challenge decisions made by their insurance providers. If a claim is denied, individuals can initiate an internal appeal directly with their insurer. Should the internal appeal be unsuccessful, patients can escalate the matter to the Washington State Office of the Insurance Commissioner, the regulatory body overseeing insurance practices in the state. This process not only provides patients with a structured avenue for recourse but also ensures that insurers are held accountable for their decisions, ultimately improving the healthcare experience for everyone in Washington.

Worst insurers in Washington by denial rate

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

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 →

Kaiser Permanente

12.4% denial rate

Kaiser denies 12.4% of claims — 6.7 points below the national average. Their appeal overturn rate is 70%.

GLP-1 Medications: 19% deniedSpecialty Medications: 15% deniedMental Health: 12% denied

Full Kaiser denial report →

Your rights as a Washington insurance patient

Washington state offers specific protections for patients facing health insurance claim denials. Individuals have the right to an internal appeal process, 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, providing an impartial evaluation of the claim. The Washington State Office of the Insurance Commissioner oversees these processes, ensuring that patients are treated fairly. Additionally, filing a complaint with this regulatory body is free and can create pressure on insurers to reconsider their decisions, further empowering patients in their pursuit of necessary healthcare services.

Washington State Office of the Insurance Commissioner
https://www.insurance.wa.gov

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How to appeal a denial in Washington

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 Washington 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 Washington State Office of the Insurance Commissioner. 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 Washingtonby claim denial rate