Centene
The dominant Medicaid managed care organization in the United States, operating in most states. Also a major ACA marketplace insurer.
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Denial Data — Centene
| Measure | 2023 | 2024 |
|---|---|---|
| ACA claim denial rate | 14% | 18% |
| ACA claims denied | 11.5M of 83.2M | 17.2M of 93.1M |
| MA prior auth denial rate | 13.6% | 12.3% |
| MA denials appealed | 8.8% | 7.6% |
| MA appeals overturned | 93.6% | 95.5% |
Centene processes more Marketplace claims than any other insurer in the data. In Medicare Advantage, its appealed denials were overturned more than 93% of the time in both years — the highest overturn rate of the major insurers — yet fewer than one in ten of its denials was ever appealed.
ACA = in-network claims on HealthCare.gov Marketplace plans. MA = Medicare Advantage prior authorization requests. Source: federal CMS data analyzed by KFF.
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