How Often Are Health Insurance Claims Denied?

In 2025, health insurance claim denials remain a widespread concern affecting millions of policyholders. Understanding how often claims are denied—and why—empowers you to navigate the system more confidently.

The Current Landscape of Claim Denials

Recent data from 2024–2025 shows that approximately 20% of health insurance claims face some form of denial. This rate reflects a steady increase from prior years, driven by rising administrative complexity, stricter coverage criteria, and inconsistent documentation. Insurers deny around 1 in 5 claims, often citing issues like missing medical codes, out-of-network care, or expired preauthorizations.

Why Claims Get Denied: Common Reasons Explained

Claim denials stem from multiple sources: administrative errors, lack of proper authorization, and policy exclusions. Many patients unknowingly receive care without verifying network status or pre-approval. Insurers also increasingly audit claims using AI tools, flagging inconsistencies in medical necessity or coding accuracy. A 2025 report by the National Association of Insurance Commissioners (NAIC) highlights that 45% of denials relate to documentation gaps, while 30% involve coding mismatches.

Supporting Keywords & Semantic Context

LSI keywords supporting the primary focus include: insurance claim denial reasons, how to appeal denied claims, health insurance coverage disputes, medical bill denial statistics, and preventive steps for claim approval.

Proactive Steps to Reduce Denial Risk

To minimize the chance of a denied claim, patients should: verify provider network status before appointments, obtain preauthorization when required, maintain complete medical records, and review benefit details online. Keeping copies of all medical correspondence strengthens appeals if denial occurs. Engaging patient advocates or using third-party verification services can further improve success rates.

Claims denial is not inevitable—awareness and preparation are your strongest defenses. Stay informed, double-check requirements, and act promptly when issues arise. If your claim is denied, appeal with clarity and supporting documentation to protect your access to care.

Call to action: Review your policy details today, confirm provider network status, and explore tools that help track claim status and support appeals. Early action saves time, reduces stress, and ensures your healthcare benefits remain fully protected.