Insurer Intelligence
Payer Appeal Playbooks
Every major commercial and Medicare Advantage insurer has unique appeal levels, dispute windows, and portal requirements. Here is how to navigate each one.
Major US Health Insurers
Updated with CY2025 CMS Disclosures#1 Commercial & MA Insurer in US60% Overturn Rate
UnitedHealthcare (Optum)
Portal: UnitedHealthcare Provider Portal / Document Vault
Standard PA Denial Rate: 17%
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Major National Commercial & MA Carrier89% Overturn Rate
Aetna / CVS Health
Portal: Availity Payer Spaces / Aetna Provider Portal
Standard PA Denial Rate: 8%
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National Commercial & Employer Sponsored72% Overturn Rate
Cigna Healthcare
Portal: CignaforHCP.com Portal
Standard PA Denial Rate: 11%
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14 State BCBS Commercial & Medicaid Carrier75% Overturn Rate
Elevance Health (Anthem BCBS)
Portal: Availity Essentials Payer Spaces
Standard PA Denial Rate: 5%
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Largest Medicaid MCO & Marketplace Carrier93% Overturn Rate
Centene Corporation (Ambetter / WellCare)
Portal: Centene Secure Provider Portal
Standard PA Denial Rate: 15%
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