Qualified Health and Dental Plan Issuers have provided annual data for total claims received and denied.
Claims received are defined as the number of claims received by an issuer asking for a payment or reimbursement by or on behalf of an in-network health care provider (such as a hospital, doctor, or dentist) that is contracted to be part of the network for an issuer.
Claims denied are a received claim that the issuer subsequently denied.
Click the links below to see the information the issuers have provided.
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Aetna CVSHealth:
2023 is this Issuer’s first year on Covered California, no data is available to report yet.
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Anthem Blue Cross:
Individual Market
2016 Total Claims Received: 7,379,867
2016 Total Claims Denied: 2,422,282
2017 Total Claims Received: 5,634,611
2017 Total Claims Denied: 1,731,253
2018 Total Claims Received: 2,331,417
2018 Total Claims Denied: 629,010
2018 Plan Level Claims
2019 Total Claims Received: 2,096,919
2019 Total Claims Denied: 401,320
2019 Plan Level Claims
2020 Total Claims Received: 2,671,617
2020 Total Claims Denied: 537,071
2020 Plan Level Claims
2021 Total Claims Received: 3,734,331
2021 Total Claims Denied: 684,859
2021 Plan Level Claims
2022 Total Claims Received: 5,650,144
2022 Total Claims Denied: 1,476,768
2022 Plan Level Claims
Qualified Dental Plan
2021 Total Claims Received: 99,246
2021 Total Claims Denied: 8,088
2021 Plan Level Claims
2022 Total Claims Received: 85,048
2022 Total Claims Denied: 12,370
2022 Plan Level Claims
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Blue Shield of California:
Individual Market
2016 Total Claims Received: 11,440,660
2016 Total Claims Denied: 494,299
2017 Total Claims Received: 19,972,661
2017 Total Claims Denied: 4,086,853
2018 Total Claims Received: 13,679,205
2018 Total Claims Denied: 4,007,226
2018 Plan Level Claims
2019 Total Claims Received: 15,076,796
2019 Total Claims Denied: 4,952,371
2019 Plan Level Claims for Individual and Small Business Markets
2020 Total Claims Received: 20,980,361
2020 Total Claims Denied: 3,935,336
2020 Plan Level Claims for Individual Market
2021 Total Claims Received: 23,496,787
2021 Total Claims Denied: 3,327,303
2021 Plan Level Claims for Individual Market
2022 Total Claims Received: 25,526,535
2022 Total Claims Denied: 4,973,797
2022 Plan Level Claims for Individual Market
Covered California for Small Business
2019 Total Claims Received: 675,405
2019 Total Claims Denied: 159,913
2019 Plan Level Claims for Individual and Small Business Markets
2020 Total Claims Received: 661,453
2020 Total Claims Denied: 107,382
2020 Plan Level Claims for Small Business Markets
2021 Total Claims Received: 953,821
2021 Total Claims Denied: 142,967
2021 Plan Level Claims for Small Business Markets
2022 Total Claims Received: 1,235,803
2022 Total Claims Denied: 233,142
2021 Plan Level Claims for Small Business Market
Qualified Dental Plan
2021 Total Claims Received: 124,408
2021 Total Claims Denied: 25,532
2021 Plan Level Claims
2022 Total Claims Received: 216,402
2022 Total Claims Denied: 45,094
2022 Plan Level Claims
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CCHP Health Plan:
Individual Market
2016 Total Claims Received: 130,290
2016 Total Claims Denied: 18,510
2017 Total Claims Received: 121,410
2017 Total Claims Denied: 19,733
2018 Total Claims Received: 40,306
2018 Total Claims Denied: 3,551
2019 Total Claims Received: 247,315
2019 Total Claims Denied: 27,640
2019 Plan Level - Individual Market
2020 Total Claims Received: 73
2020 Total Claims Denied: 6
2020 Plan Level Claims
2021 Total Claims Received: 121,248
2021 Total Claims Denied: 14,101
2021 Plan Level Claims
2022 Total Claims Received: 139,430
2022 Total Claims Denied: 21,918
2022 Plan Level Claims
Covered California for Small Business:
2018 Total Claims Received: 644
2018 Total Claims Denied: 63
2018 Plan Level Claims for Individual and Small Business Markets
2019 Plan Level - Covered California for Small Business
2020 Total Claims Received: 3
2020 Total Claims Denied: 0
2020 Plan Level Claims for Individual and Small Business Markets
Pharmacy Claims
2020 Total Claims Received: 52,721
2020 Total Claims Denied: 7,572
2020 Plan Level – Pharmacy Claims
2021 Total Claims Received: 45,159
2021 Total Claims Denied: 8,484
2021 Plan Level – Pharmacy Claims
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California Dental Network:
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Delta Dental:
Individual Market
2020 Total Claims Received: 416,838
2020 Total Claims Denied: 106,743
2020 Plan Level Claims for Individual Market
2021 Total Claims Received: 597,388
2021 Total Claims Denied: 154,853
2021 Plan Level Claims for Individual Market
2022 Total Claims Received: 592,609
2022 Total Claims Denied: 161,860
2022 Plan Level Claims
Covered California for Small Business
2020 Total Claims Received: 12,782
2020 Total Claims Denied: 2,626
2020 Plan Level Claims for Small Business Market
2021 Total Claims Received: 19,984
2021 Total Claims Denied: 4,370
2021 Plan Level Claims for Small Business Market
2022 Total Claims Received: 22,591
2022 Total Claims Denied: 4,770
2022 Plan Level Claims
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Dental Health Services:
Individual Market
2020 Total Claims Received: 10,350
2020 Total Claims Denied: 1,141.
2020 Plan Level Claims
2021 Total Claims Received: 12,131
2021 Total Claims Denied: 943
2021 Plan Level Claims
2022 Total Claims Received: 5,575
2022 Total Claims Denied: 1,636
2022 Plan Level Claims
Covered California for Small Business
2020 Total Claims Received: 58
2020 Total Claims Denied: 12
2021 Total Claims Received: 78
2021 Total Claims Denied: 6
2021 Plan Level Claims
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Health Net:
Individual Market
2016 Total Claims Received: 4,193,245
2016 Total Claims Denied: 1,064,132
2017 Total Claims Received: 4,196,039
2017 Total Claims Denied: 983,962
2018 Total Claims Received: 4,869,669
2018 Total Claims Denied: 1,235,568
2018 Plan Level Claims for Individual and Small Business Markets
2019 Total Claims Received Health Net CA: 4,360,370
2019 Total Claims Received Health Net Life: 1,391,757
2019 Total Claims Denied Health Net CA: 1,069,370
2019 Total Claims Denied Health Net Life: 285,738
2019 Plan Level Claims for Individual Market
2020 Total Claims Received Health Net CA: 2,980,962
2020 Total Claims Received Health Net Life: 639,095
2020 Total Claims Denied Health Net CA: 974,647
2020 Total Claims Denied Health Net Life: 222,044
2020 Plan Level Claims for Individual Market HNL
2020 Plan Level Claims for Individual Market HNCA
2021 Total Claims Received HNCA: 3,155,848
2021 Total Claims Denied HNCA: 1,030,404
2021 Total Claims Received HNL: 776,909
2021 Total Claims Denied HNL: 253,406
2021 Plan Level Claims for Individual Market HNL
2021 Plan Level Claims for Individual Market HNCA
2022 Total Claims Received HNCA: 2,609,896
2022 Total Claims Denied HNCA: 1,235,601
2022 Plan Level Claims for HNCA
Covered California for Small Business:
2016 Total Claims Received: 202,531
2016 Total Claims Denied: 37,668
2017 Total Claims Received: 163,893
2017 Total Claims Denied: 31,749
2018 Total Claims Received: 86,951
2018 Total Claims Denied: 16,969
2018 Plan Level Claims for Individual and Small Business Markets
2019 Total Claims Received: 82,902
2019 Total Claims Denied: 15,774
2019 Plan Level Claims for Small Business Market
2020 Total Claims Received Health Net Life: 27,678
2020 Total Claims Denied Health Net Life: 10,461
2020 Plan Level Claims for Small Business Market
2021 Total Claims Received: 10,296
2021 Total Claims Denied: 2,908
2021 Plan Level Claims for Small Business Market HNL
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Inland Empire Health Plan:
2024 is this Issuer’s first year on Covered California, no data is available to report yet.
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Kaiser Permanente:
2024 is this Issuer’s first year on Covered California, no data is available to report yet.
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LA Care Health Plan:
Individual Market
2016 Total Claims Received: 138,702
2016 Total Claims Denied: 40,714
2017 Total Claims Received: 588,009
2017 Total Claims Denied: 138,741
2018 Total Claims Received: 399,749
2018 Total Claims Denied: 225,330
2018 Plan Level Claims
2019 Total Claims Received: 925,611
2019 Total Claims Denied: 324,593
2019 Plan Level Claims
2020 Total Claims Received: 751,782
2020 Total Claims Denied: 324,593
2020 Plan Level Claims for Individual Market
2021 Total Claims Received: 1,054,208
2021 Total Claims Denied: 500,434
2021 Plan Level Claims for Individual Market
2022 Total Claims Received: 1,060,825
2022 Total Claims Denied: 541,329
2022 Plan Level Claims
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Molina Healthcare:
Individual Market
2016 Total Claims Received: 407,542
2016 Total Claims Denied: 106,879
2017 Total Claims Received: 1,795,165
2017 Total Claims Denied: 726,164
2018 Total Claims Received: 798,487
2018 Total Claims Denied: 267,100
2018 Plan Level Claims
2019 Total Claims Received: 805,494
2019 Total Claims Denied: 253,330
2019 Plan Level Claims
2020 Total Claims Received: 833,048
2020 Total Claims Denied: 339,905
2020 Plan Level Claims for Individual Market
2021 Total Claims Received: 1,043,834
2021 Total Claims Denied: 280,468
2021 Plan Level Claims for Individual Market
2022 Total Claims Received: 603,305
2022 Total Claims Denied: 141,189
2021 Plan Level Claims
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Oscar:
Individual Market
2016 Total Claims Received: 66,294
2016 Total Claims Denied: 11,493
2017 Total Claims Received: 179,770
2017 Total Claims Denied: 21,883
2018 Total Claims Received: 336,279
2018 Total Claims Denied: 50,394
2018 Plan Level Claims
2019 Total Claims Received: 210,468
2019 Total Claims Denied: 12,670
2019 Plan Level Claims
2020 Total Claims Received: 101,910
2020 Total Claims Denied: 47,514
2020 Plan Level Claims for Individual Market
2021 Total Claims Received: 1,320,763
2021 Total Claims Denied: 41,221
2021 Plan Level Claims for Individual Market
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Sharp Health Plan:
Individual Market
2016 Total Claims Received: 365,452
2016 Total Claims Denied: 61,367
2017 Total Claims Received: 477,165
2017 Total Claims Denied: 83,844
2018 Total Claims Received: 681,384
2018 Total Claims Denied: 107,076
2018 Plan Level Claims
2019 Total Claims Received: 397,846
2019 Total Claims Denied: 69,493
2019 Plan Level Claims
2020 Total Claims Received: 703,496
2020 Total Claims Denied: 64,283
2020 Plan Level Claims
2021 Total Claims Received: 410,376
2021 Total Claims Denied: 98,672
2021 Plan Level Claims
2022 Total Claims Received: 1, 654,431
2022 Total Claims Denied: 271,895
2022 Plan Level Claims
Covered California for Small Business
2021 Total Claims Received: 52,096
2021 Total Claims Denied: 11,457
2021 Plan Level Claims
2022 Total Claims Received: 51,628
2022 Total Claims Denied: 9,852
2022 Plan Level Claims
Pharmacy
2020 Total Claims Received: 231,786 Individual; 45,716 Small Group
2020 Total Claims Denied: 59,506 Individual; 11,016 Small Group
2020 Plan Level Claims for Individual Market
2020 Plan Level Claims for Small Business Market
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Valley Health Plan:
Individual Market
2016 Total Claims Received: 26,312
2016 Total Claims Denied: 7,713
2017 Total Claims Received: 53,166
2017 Total Claims Denied: 16,402
2018 Total Claims Received: 99,350
2018 Total Claims Denied: 19,783
2018 Plan Level Claims
2019 Total Claims Received: 91,561
2019 Total Claims Denied: 9,070
2019 Plan Level Claims
2020 Total Claims Received: 279,096
2020 Total Claims Denied: 29,464
2020 Plan Level Claims for Individual Market
2021 Total Claims Received: 519,913
2021 Total Claims Denied: 27,863
2021 Plan Level Claims for Individual Market
2022 Total Claims Received: 470,637
2022 Total Claims Denied: 92,068
2022 Plan Level Claims
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Western Health Advantage (WHA):
WHA is unable to provide complete claims denial data. Under WHA's fully-delegated model of care, our delegated entities (medical groups, IPAs, hospitals, ancillary providers) do not provide WHA with claims denial data. WHA’s claim denial data is limited to the claims processed directly by the health plan and those are specific to out of area emergency and urgent claims.
2016 Total Claims Received: 2,116
2016 Total Claims Denied: 157
2017 Total Claims Received: 2,804
2017 Total Claims Denied: 200
2018 Total Claims Received: 4,250
2018 Total Claims Denied: 224
2018 Plan Level Claims
2019 Total Claims Received: 4,143
2019 Total Claims Denied: 407
2019 Plan Level Claims
2020 Total Claims Received: 4,271
2020 Total Claims Denied: 360
2020 Plan Level Claims for Individual Market
2021 Total Claims Received: 13,240
2021 Total Claims Denied: 1,246
2021 Plan Level Claims for Individual Market
2022 Total Claims Received: 2,684
2022 Total Claims Denied: 104
2022 Plan Level Claims
