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Data & benchmarks
Federal IDR win rates by payer
How often providers win out-of-network disputes under the No Surprises Act, broken down by insurance payer. Computed from the CMS Federal IDR Public Use Files for 2025 — payer-level outcomes consolidated into canonical payer families, weighted by decided line items.
~85.8%
provider win rate, all payers (2025)
Aetna
highest of the big four (~90.5%)
Cigna
lowest of the big four (~81.0%)
Provider win rate by payer
| Payer | Win rate | Decided line items | Notes |
|---|---|---|---|
| Aetna | 90.5% | ~845,000 | Highest of the four national carriers. |
| Centene / Ambetter | 90.1% | ~122,000 | Marketplace-heavy; providers prevail often. |
| Oscar | 90.3% | ~13,000 | Smaller volume, high provider win rate. |
| Blue Cross Blue Shield | 87.0% | ~1,840,000 | Largest dispute volume in the data. |
| Anthem / Elevance | 86.9% | ~206,000 | Blues licensee, tracked separately. |
| UnitedHealthcare (incl. UMR / Optum) | 83.8% | ~1,560,000 | Second-largest volume; below the average. |
| Cigna | 81.0% | ~640,000 | Lowest of the big four — the toughest. |
| Kaiser | 74.5% | ~45,000 | Lowest among the major payers shown. |
CMS Federal IDR Public Use Files, calendar year 2025; win rate = provider-prevailing line items ÷ decided line items, consolidated across payer name variants. Figures rounded. Individual practices vary widely — many self-filing groups win well below these averages.
What the payer data shows
- Providers win the majority against every major payer. Even the toughest — Cigna at ~81% and Kaiser at ~74.5% — still lose most of their contested determinations.
- The big four split into two tiers. Aetna (~90.5%) and Blue Cross Blue Shield (~87%) sit above the average; UnitedHealthcare (~84%) and Cigna (~81%) sit below it.
- Volume is concentrated. Blue Cross Blue Shield and UnitedHealthcare together account for over 3.4 million of the ~5.46 million decided line items — so how you handle those two payers moves your recovery the most.
Know your own win rate by payer
These are national averages. Sydra shows you your win and default rates by payer and CPT from the same CMS data — and closes the gap for a flat fee.
Medically & clinically reviewed by Dr. John M. Abrahams, MD
Board-certified neurosurgeon and founder of Sydra · Last reviewed September 2026 · About the author
Sources
Figures reflect the published federal record across all disputes, not a prediction about any individual claim. This is general information, not legal or financial advice.