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Insurer Complaint Index

Benchmark denial rates, complaint statistics, and appeal overturn data from public regulatory sources.

All data from primary public sources — KFF, CMS/HHS OIG, NAIC, and Financial Ombudsman Service. Insurer-level NAIC complaint ratios link directly to the NAIC tool for real-time data.

Industry Benchmarks

17%
ACA Marketplace Denial Rate
Median in-network claim denial rate across ACA marketplace plans in 2022.
< 0.2%
Denied Claims That Are Appealed
Less than 1 in 500 denied ACA marketplace claims are appealed by enrollees.
75%
Medicare Advantage Appeal Overturn Rate
75% of fully-appealed Medicare Advantage prior auth denials were overturned in favour of patients.
38%
UK PMI Complaints Upheld by FOS
The Financial Ombudsman Service upheld 38% of private medical insurance complaints in favour of consumers in 2022/23.

US Insurer Complaint Ratios (NAIC)

NAIC complaint ratios measure confirmed consumer complaints per $1 million in premium — lower is better. Insurer-level ratios are published by the NAIC and updated annually. Click any insurer to look up their current ratio.

InsurerNAIC Complaint RatioDenial Pages
UnitedHealthcare
Cigna / Evernorth
Aetna (CVS Health)
Anthem / Elevance Health
Humana
Kaiser Permanente
Blue Cross Blue Shield (BCBS)
Molina Healthcare
Centene / Ambetter
Oscar Health
Source: NAIC Consumer Insurance Information Source. Complaint ratios for Accident & Health lines, most recent year available.

About This Index

ClaimBack only displays data that can be directly cited to a primary public source. Where insurer-level figures are not available in a reliably-dated, machine-readable public dataset, we link to the source tool directly rather than show potentially stale or estimated values. See our data sources page and methodology for full details.

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