What Percentage of Claims Does Cigna Deny?

If you are asking what percentage of claims does Cigna deny, the honest answer is that no one publishes that number for dental. The figures circulating online come from federal transparency data on individual market medical plans and from 2023 reporting on a medical claim review process. Neither describes the DPPO and DHMO claims your office files. Commonly quoted marketplace denial rates sit in the high teens as a percentage across all issuers, with wide variation plan by plan. The rate that moves your collections is the one you measure yourself.

That is not a dodge. Here is where the public numbers come from, why they do not transfer to a dental office, and how to build a Cigna denial rate you can act on this week.

Where the numbers you have seen come from

Almost every percentage you will find traces back to one of three places.

Federal marketplace transparency data. Issuers selling qualified health plans on HealthCare.gov report claims received and claims denied to CMS, and the files are public. Issuer level in network denial rates published from them each year spread from single digits to more than a third, with the all issuer average commonly quoted in the high teens. As of this writing that data covers medical claims on individual market plans. It excludes employer coverage and standalone dental plans, which is most of what a dental office bills.

The 2023 PxDx reporting. ProPublica and The Capitol Forum reported in March 2023 that over two months, Cigna medical directors declined more than 300,000 payment requests through an automated review system called PxDx, averaging roughly 1.2 seconds per case according to internal documents. The company disputed that characterization, describing PxDx as a post service check of whether a procedure code matches the submitted diagnosis rather than a medical necessity review. What is not in dispute is the line of business: those were medical claims, not dental ones.

Practice anecdote. Forum threads full of denied Cigna claims are real experience and poor data: self selected, rarely separating a rejection from a denial, almost never stating a denominator.

What each available source actually covers:

Which insurance company denies most claims?

There is no stable answer, and any article handing you a single ranked list is telling you more about its data source than about the carriers. The order moves year to year, it changes depending on whether you count claims or lines, and the largest published dataset covers a slice of the market dental practices do not bill.

The useful version is smaller and answerable: which of my payers denies the most of my claims? Pull twelve months of remittances, group by payer, count denied lines against adjudicated lines. The result usually surprises, because the payer that feels worst at the front desk is rarely the one with the highest denial rate. It is the one with the slowest payment, or the widest gap between benefits quoted at verification and the allowed amount on the remittance.

Is Cigna considered the worst health insurance company?

No consensus exists, and worst is not a measurable category. What is measurable is the NAIC complaint index, which compares a carrier's share of consumer complaints to its share of premium in one market. An index of 1.0 is exactly the share its size predicts, and above 1.0 is more. Look yours up by state through the National Association of Insurance Commissioners consumer tools: a state level index says more about what your patients will meet than any national reputation ranking.

For the practice, rank payers on four numbers you already own: days from submission to payment, percentage of lines denied on first adjudication, percentage of denials overturned on appeal, and how often quoted benefits match the remittance. Run it for every payer and the argument about who is worst stops being an argument.

One caution applies to every carrier. Plan provisions are chosen by the employer group, not by the brand on the card. Two patients with Cigna coverage can carry different frequency limits, waiting periods, missing tooth language and annual maximums, so a denial pattern on one group predicts nothing about the next. Verify per plan, every time, and record the reference number with the date.

Which health insurance company rejects the most claims?

Before ranking anyone, separate the two events being counted, because most offices mix them.

A rejection happens before adjudication, at your clearinghouse or the payer's front end. The claim comes back for a data problem: an invalid member ID, a missing tooth number or surface, a subscriber name that does not match. No remittance, no reason code, no appeal rights, and the timely filing clock is still running. You fix it and resubmit.

A denial is an adjudicated decision. It arrives on a remittance with a claim adjustment reason code, and it carries appeal rights and a deadline.

Counting them together wrecks the number in both directions. Watch what one illustrative month of 100 Cigna claims from a single office does to the arithmetic.

Four defensible percentages, one month, one office, one payer. Anyone quoting a denial rate without saying which one they mean is quoting noise. Keep rejections in a separate report, because a rejection rate above roughly 5 percent points at intake and claim build rather than at the carrier, as our guide to dental claim authorization bottlenecks covers.

Why are doctors dropping Cigna?

The reasons practices give, for this carrier and for others, fall into four groups.

Fee schedule level. The contracted rate against the real cost of the procedure, which moves with staffing and lab costs while schedules often do not.

Leased network access. A contract signed with one network can be leased to other payers, so a discount you agreed to once shows up on patients you never expected. Read the third party access language in the participating provider agreement before blaming a carrier for a rate you did not recognize.

Documentation load. Predeterminations, radiograph requests, narrative requests, and repeat requests for material already sent.

Reductions that are not denials. An alternate benefit provision or a bundling edit lowers the allowed amount with no denial code on the remittance, which is why these get written off instead of collected. Our explainer on what an alternate benefit provision means covers how to spot one.

Before terminating anything, do the arithmetic. Say a payer brings 100 patients a year at 1,000 dollars of full fee production each, and its schedule averages 20 percent below your fee. In network you collect about 80,000 dollars. Out of network you bill full fee, so you break even at 80 patients retained. Lose more than a fifth of that panel and you are behind, before the collection risk of larger patient balances. Check your agreement for the termination notice period, commonly 60 to 90 days, and confirm state requirements with your state insurance department, since those rules change.

Work the reason codes, not the reputation

Denial reasons cluster tightly in dental. These six cover most of what arrives, and each points at a different owner inside the office.

Code wording above is paraphrased, so read the description on your own remittance before appealing. Three categories repay the effort of a real appeal: medical necessity denials on endodontics, covered in why dental insurance denies a root canal, prosthetic denials on implants, covered in why an implant claim gets denied, and disputes where the payer asserts a higher level service was billed, covered in how to overcome a denial for upcoding. When a denial is final, whether you may bill the patient turns on your participating provider agreement and the plan language, which we work through in can a dentist bill the patient if insurance denies the claim.

Curo reads every remittance line against the estimate that produced it, groups denials by payer and reason code, and routes the appealable ones to whoever works them, which turns a denial rate from a number you quote into a list you clear. See denial management.

Whatever you conclude about the public figures, do one thing before your next contract review: run a twelve month denial report by payer and reason code. A practice that can say its first pass line level denial rate with a payer is 7.2 percent, that most of those denials are frequency related, and that a solid share of appealed ones were overturned, is in a different conversation than one that says the payer denies everything. The first gets changes made. The second gets sympathy.