A new Commonwealth Fund survey finds that one in five (21%) U.S. working-age adults with private insurance reported that they or a family member were denied insurance coverage for doctor-recommended medical care in the past year. The survey examines two distinct types of denials: prior authorization denials, which occur before care is received, and claim denials, which occur after care has already been provided.
The report, How Health Insurance Coverage Denials Affect Americans, draws on findings from the Commonwealth Fund 2025 Affordability Survey of U.S. adults ages 19 to 64, including responses from 4,589 adults with private insurance, as well as eight online focus groups in which participants described denials as eroding their trust in both insurers and health care providers. Private insurance includes coverage through an employer, the Affordable Care Act marketplaces, or the individual market.