What is Cigna's denial rate? It depends on the book of business. In KFF's analysis of 2024 HealthCare.gov data, Cigna Health denied 20.8% of in-network ACA Marketplace claims, slightly above the 19% average. Cigna's own CMS disclosure for its 2025 exchange plans reports 27% of standard prior-authorization requests denied. Across its core medical business, Cigna says about 95% of 2025 claims were approved and paid on first submission. Each figure measures something different.
Cigna's ACA Marketplace Claim Denial Rate: 20.8%
The most comparable public Cigna figure is 20.8%, the 2024 in-network claim denial rate KFF calculated for Cigna Health across its HealthCare.gov states. That puts Cigna about two points above the 19% average for all HealthCare.gov issuers and in the middle of the large-insurer pack.
KFF's parent-company table covers insurers that received more than 5 million claims in 2024, built from CMS Transparency in Coverage public use files. Cigna Health received 18,151,575 in-network claims across 8 HealthCare.gov states and denied 3,777,467 of them.
| 2024 HealthCare.gov Parent Company | In-Network Claims Received | In-Network Denial Rate |
|---|---|---|
| UnitedHealth Group | 14,022,287 | 33.3% |
| Health Care Service Corporation | 25,094,529 | 29.2% |
| Molina Healthcare | 5,339,437 | 26.4% |
| Elevance Health | 10,574,417 | 23.2% |
| CVS Health (Aetna) | 31,419,396 | 21.6% |
| Cigna Health | 18,151,575 | 20.8% |
| Oscar Health | 19,655,916 | 17.1% |
| Centene Corporation | 83,192,384 | 13.8% |
| All HealthCare.gov issuers | — | 19% |
Key takeaway: Cigna is neither an outlier nor a low denier in this cohort. Its 2024 ACA Marketplace rate sits 0.8 points below CVS Health and 12.5 points below UnitedHealth Group. For the full multi-payer view, see the insurance denial rate comparison by company.
Why You May Have Seen About 19% for Cigna
Some third-party summaries list Cigna at about 19%, which is also the HealthCare.gov average. Figures differ with how an analysis groups issuers and parent companies. KFF's parent-company table, built directly from the CMS files, puts Cigna Health at 20.8% for 2024 in-network claims.
Cigna Denial Rates by State (ACA Marketplace)
Cigna's Marketplace denial rate ranged from about 16% to 28% across the states where its issuers reported 2024 data. The highest rate was Mississippi's, at 27.7%.
Prepare this appeal packet with your team.
Draft the appeal, coordinate missing documents, and approve the reviewed packet. Keep your clearinghouse; your practice checks deadlines and submits through the payer’s accepted channel.
First 3 appeals free, then $20 per appeal. Start with your denial letter or EOB and available records. No meeting or clearinghouse connection required.
The rows below come from KFF's downloadable 2024 issuer-level transparency working file, which lists seven Cigna issuer entries. KFF's published parent-company total counts 8 states, so the seven rows do not add up exactly to the 18.2 million total above.
| State | Cigna Issuer | In-Network Claims | In-Network Denial Rate |
|---|---|---|---|
| Mississippi | Cigna Health and Life Insurance Company | 2,495,922 | 27.7% |
| Texas | Cigna HealthCare of Texas, Inc. | 4,080,439 | 21.7% |
| Tennessee | Cigna Health and Life Insurance Company | 4,704,089 | 20.3% |
| Florida | Cigna Health and Life Insurance Company | 4,620,013 | 20.0% |
| Indiana | Cigna Health and Life Insurance Company | 384,617 | 19.6% |
| Arizona | Cigna HealthCare of Arizona, Inc. | 139,645 | 16.2% |
| North Carolina | Cigna HealthCare of North Carolina, Inc. | 1,009,831 | 16.1% |
State rates reflect each issuer's own Marketplace members, claim mix, and network. They do not predict the denial rate for an employer plan administered by Cigna in the same state.
Cigna Prior Authorization Denial Rates
For Cigna's 2025 individual and family exchange plans, Cigna's own CMS disclosure reports that 27% of standard and 22% of expedited prior-authorization requests were denied. Across its broader business, Cigna says fewer than 2% of customers had a prior authorization denied in 2025.
These two figures do not conflict. The exchange report counts denied requests, while the company-wide figure counts customers, and most customers never need a prior authorization.
| Metric | Figure | Population and Source |
|---|---|---|
| Standard PA requests approved / denied | 73% / 27% | Cigna IFP exchange plans, CY 2025, Cigna CMS disclosure |
| Expedited PA requests approved / denied | 78% / 22% | Cigna IFP exchange plans, CY 2025, Cigna CMS disclosure |
| Average standard decision time | 3.95 days | Cigna IFP exchange plans, CY 2025 |
| Average expedited decision time | 1.53 days | Cigna IFP exchange plans, CY 2025 |
| Customers who went through PA | Less than 6% | Cigna Healthcare U.S. core medical + Express Scripts, 2025 |
| Customers with a PA denial | Less than 2% | Same population; initial denials, some later approved |
| Medical PAs approved in one day or less | About 80% | Share of approved Cigna Healthcare U.S. medical PAs |
| Medical PA requests submitted electronically | Nearly 65% | Cigna Healthcare U.S. core medical |
The exchange figures come from Cigna's CMS IFP FFE Prior Authorization Disclosure Report for calendar year 2025. The company-wide figures come from The Cigna Group's 2025 Customer Transparency Report. The same report says Cigna removed 345 tests, procedures, and services from its U.S. prior-authorization list, which it estimates cut medical PA volume by about 521,000 requests (about 15%).
Some Cigna specialty authorizations, such as certain advanced imaging and musculoskeletal services, are managed by EviCore rather than by Cigna directly. A denial from EviCore follows EviCore's own review and appeal steps. See the Cigna EviCore appeal guide before filing.
Cigna's Company-Wide Claim Approval Rate
Cigna reports that about 95% of its roughly 155 million 2025 medical claims were approved and paid on original submission. That leaves roughly 5% that were denied or pended for more information at first pass.
The figure is self-reported and defined differently from KFF's rate. Per the report's footnotes, it covers Cigna Healthcare's core U.S. medical book (excluding dental and international). It divides approved claims by all approved, denied, and pended claims at initial receipt, before resubmissions or appeals.
| Figure | What It Measures | Why It Differs |
|---|---|---|
| 20.8% denied (KFF, 2024) | In-network ACA Marketplace claims, HealthCare.gov states | Individual market only; ultimately denied claims, excluding initial denials subsequently resubmitted and paid |
| ~95% approved and paid (Cigna, 2025) | Original claims across Cigna's core U.S. medical book | Mostly employer business; the ~5% remainder mixes denials and pends; self-reported |
| 27% of standard PA requests denied (Cigna, 2025) | Prior-authorization requests on exchange plans | Pre-service requests, not submitted claims |
| <2% of customers with a PA denial (Cigna, 2025) | Unique customers with an initial PA denial | Denominator is all members, most of whom never need PA |
Do Not Mix Denominators
A claim denial rate, a prior-authorization denial rate, and a share-of-customers figure answer three different questions. Compare Cigna with another insurer only when the market, year, and denominator match, as in the KFF parent-company table.
Cigna Appeal and Overturn Statistics
Very few denied Cigna Marketplace claims are appealed, but those that are get overturned fairly often. In KFF's 2024 issuer file, Cigna's seven issuers recorded 3,627 internal appeals against more than 4.3 million denied claims, and 1,743 of those appeals were overturned (about 48%).
That 48% is a Muni calculation from the KFF working file, and small-count cells are suppressed in the source data. By state, the overturn share ranged from 26% (North Carolina, 39 of 150) to 64% (Texas, 755 of 1,184). Nationally, KFF reports that fewer than 1% of denied HealthCare.gov claims were appealed in 2024 and that insurers upheld 66% of the denials that were.
Cigna's 2025 exchange prior-authorization disclosure reports a lower figure for pre-service appeals: 16% of appeals overturned. Claim appeals and prior-authorization appeals are separate processes with different evidence, so one rate should not stand in for the other.
What about Cigna Medicare Advantage?
There is no current Cigna-specific Medicare Advantage denial rate to cite. Cigna sold its Medicare Advantage, Part D, and CareAllies businesses to Health Care Service Corporation, which completed the acquisition on March 19, 2025. Those plans now operate as HealthSpring.
KFF's 2024 Medicare Advantage prior-authorization analysis does not break out Cigna. Across all MA insurers, it reports 7.7% of 52.8 million determinations denied and 80.7% of appealed denials overturned. For former Cigna MA members, follow the HealthSpring prior authorization guide.
Why Cigna Claims Get Denied
No public source gives a reliable Cigna-specific percentage breakdown by denial reason. For HealthCare.gov plans overall, KFF's 2024 data attributes 25% of in-network denial reasons to administrative issues, 13% to excluded services, 9% to missing prior authorization or referral, and 5% to medical necessity. Another 36% fall under "other."
Use the Cigna EOB or denial letter to identify the actual reason, then match the response to it:
| Denial Reason | What to Check Before Responding |
|---|---|
| Coding edit or bundling | Whether a claim reconsideration or corrected claim fixes it faster than a formal appeal |
| Missing precertification | Cigna's current Master Precertification List for the date of service, and whether EviCore managed the service |
| Medical necessity | The Cigna coverage policy cited, its effective date, and a record that addresses each criterion |
| Timely filing | Clearinghouse acceptance reports or payer receipts proving on-time submission |
| Excluded or non-covered service | The member's benefit plan language; self-funded employer plans can differ from Cigna's standard policies |
For EOB-based triage, use the Cigna denied claim guide. For filing windows, see Cigna timely filing limits.
How to Respond to a Cigna Denial
Cigna's provider appeal is a single-level internal review filed within 180 calendar days of the initial payment or denial notice. That deadline comes from Cigna's appeals and disputes page for providers. Cigna says the review is completed in 60 days, and arbitration may be requested within one year of the final internal decision letter.
Prepare this appeal packet with your team.
Draft the appeal, coordinate missing documents, and approve the reviewed packet. Keep your clearinghouse; your practice checks deadlines and submits through the payer’s accepted channel.
First 3 appeals free, then $20 per appeal. Start with your denial letter or EOB and available records. No meeting or clearinghouse connection required.
- Confirm who decided. Check whether the letter came from Cigna, EviCore, or (for Medicare Advantage) HealthSpring. Each has its own route.
- Pick the right lane. Coding-edit issues can often go through a claim reconsideration on CignaforHCP rather than a formal appeal.
- Match evidence to the stated reason. For clinical denials, include the narrative, operative notes, and records that address the specific Cigna coverage policy cited.
- Calendar the 180 days. Your participation agreement or the member's plan documents may set different terms, so verify them for self-funded plans.
- Log the submission. Record the date, method, and any confirmation number in case you escalate to arbitration or external review.
Step-by-step filing is covered in how to appeal Cigna denials, and a ready-to-edit letter is in the Cigna appeal letter template.
Muni Appeals drafts Cigna appeal letters from the denial notice and records you upload, maps the evidence to the cited reason, and gives your team a draft to review and send. It does not guarantee an outcome.
Frequently Asked Questions
What percentage of claims does Cigna deny?
In KFF's 2024 HealthCare.gov analysis, Cigna Health denied 20.8% of in-network ACA Marketplace claims, compared with a 19% average. Cigna separately reports that about 95% of its roughly 155 million 2025 core medical claims were approved and paid on first submission. That self-reported figure covers mostly employer business and counts pended claims with denials in the remaining 5%.
Does Cigna deny more claims than other insurers?
In the 2024 HealthCare.gov parent-company table, Cigna's 20.8% was below UnitedHealth Group (33.3%), HCSC (29.2%), Molina (26.4%), Elevance (23.2%), and CVS Health (21.6%). It was above Oscar (17.1%) and Centene (13.8%). That ranking applies only to ACA Marketplace claims. See the UHC denial rate statistics and Aetna denial rate statistics for the same comparison from other payers' angles.
What is Cigna's prior authorization denial rate?
For Cigna's 2025 individual and family exchange plans, Cigna reports denying 27% of standard and 22% of expedited prior-authorization requests. Across its broader business, fewer than 2% of Cigna customers had an initial PA denial in 2025, according to The Cigna Group's 2025 transparency report.
What percentage of Cigna appeals are successful?
In KFF's 2024 issuer data, about 48% of internal appeals on Cigna's Marketplace claims were overturned (1,743 of 3,627, Muni calculation). Cigna's 2025 exchange prior-authorization disclosure reports that 16% of PA appeals were overturned. Neither figure predicts the outcome of an individual appeal.
How long do I have to appeal a Cigna denial?
Cigna's provider appeals page gives 180 calendar days from the initial payment or denial notice for a single-level internal appeal. Arbitration may be requested within one year of the final internal decision. Always confirm against the denial letter and your agreement.
Does Cigna still have Medicare Advantage plans?
No. HCSC completed its acquisition of Cigna's Medicare Advantage and Part D businesses on March 19, 2025, and those plans now operate as HealthSpring. Cigna-branded commercial and exchange plans are unaffected.
The Bottom Line
The sourced Cigna numbers are specific, not universal:
- 20.8% of 2024 in-network ACA Marketplace claims denied, versus a 19% HealthCare.gov average (KFF).
- 27% of standard and 22% of expedited 2025 exchange-plan prior-authorization requests denied (Cigna CMS disclosure).
- About 95% of 2025 core medical claims approved and paid on first submission (Cigna, self-reported).
- About 48% of Marketplace claim appeals overturned in 2024 (Muni calculation from KFF data), even though fewer than 1 in 1,000 denials were appealed.
The practical read for a billing team is the same across all of them. Most Cigna denials are never challenged, so a correctly routed, well-documented appeal filed inside 180 days is worth the effort.
→ Prepare a Cigna Appeal with Muni
Sources: KFF, Claims Denials and Appeals in ACA Marketplace Plans in 2024 (published March 24, 2026) and its issuer-level working file; Cigna CMS IFP FFE Prior Authorization Disclosure Report, CY 2025; The Cigna Group 2025 Customer Transparency Report; KFF, Medicare Advantage Prior Authorization Determinations in 2024 (published January 28, 2026); HCSC completes acquisition of Cigna's Medicare businesses; Cigna provider appeals and disputes. This article is general administrative information, not legal advice; verify deadlines and routes against the current denial notice and your Cigna agreement.