News: 1 in 5 privately insured adults reported coverage denials last year, survey finds

Twenty-one percent of privately insured United States working-age adults had coverage denied for themselves or a family member for medical care recommended by a doctor in the past year, either before or after the care was provided, according to the Commonwealth Fund 2025 Affordability Survey.

The survey, conducted last year and published June 4, analyzed responses from nearly 4,600 individuals with private insurance.

Other main findings from the survey include:

1. That 21% stemmed from 13% of surveyed adults reporting prior authorization denials, 8% reporting claim denials and 1% reporting both.
2. Forty-one percent of people who faced a prior authorization denial said it prompted a delay in medical care, while 28% said a health problem worsened as a result.
3. Sixty-three percent of those with a prior authorization denial found that added worry and anxiety.
4. Almost 70% of those who received a claim denial said it cost their household more money.
5. About half of those who received a claim denial appealed, but insurers still rejected one-third of the appeals. The wait time for appealed claims was at least one month for more than 60% of people who had tried and received an answer.
6. Nearly 90% of people with a coverage denial blamed their insurance company.

Only about half who experienced a denial appealed the decision, citing uncertainty about their right to do so and whether it mattered, along with confusion regarding who to contact to file the appeal.

Editor’s note: To read the full study, click here. To read additional coverage by the American Hospital Association, click here.