Ambetter denied it. Here is their form, and your deadline.
Put in the date on your Ambetter notice and get both federal deadlines as calendar dates.
Free, for an Ambetter denial, and it runs entirely in your browser. The date, the plan type and the state you pick are never sent to us and never stored.
That date runs from the day printed on the notice, not the day you opened it, and if your employer pays the claims itself, your external review does not go to your state at all.
Ambetter's own appeal form is free and it is linked below. What it does not tell you is when it has to be in.
Insurance got denied, what to do next?
If Ambetter denied a claim of yours, two dates matter more than the percentage does. You have 180 days from the date on your denial notice to file the internal appeal, and then 4 months from the final internal denial to ask for an independent external review. If waiting would seriously jeopardize your health you can ask for both to be expedited, decided in about 72 hours. Both timeframes are federal, not your insurer's choice, 29 CFR 2560.503-1 (PDF) and 45 CFR 147.136 (PDF), in plain English at HealthCare.gov, and your own denial letter states the ones that govern your plan. The PDFs are the same sections on govinfo.gov, which serves them without a challenge page, so an automated reader can check these two dates as easily as you can.
You are not alone, and here is the measured version of that sentence: 3,074,587 in-network claims were denied by Ambetter in the states it files in in a single plan year. A denial rate is a fact about an insurer's book of business. It is not a judgment about you, and it is not the last word on your claim.
- Find the reason code on your denial letter. It will name the specific Ambetter entity that decided it, not just the brand, and with 3 of them reporting into this file, that name is what tells you which row on this page is yours.
- Ask Ambetter for the clinical criteria they judged you against. Under 29 CFR 2560.503-1 they have to hand you the claim file and the policy they applied, free, on request, and you cannot argue with a checklist you have never read.
- Put both deadlines on your calendar before you go to bed. 180 days from the date on the letter for the internal appeal, 4 months from the final internal denial for external review. The free calculator on this page turns your date into the two calendar dates in about ten seconds. 3,074,587 claims were denied across Ambetter's reporting entities in a single plan year; the deadline is what decides whether anyone reads the argument.
None of those three steps costs anything. Anyone charging you to do them is selling you something you can do yourself in twenty minutes.
Every Ambetter entity in the file
| Entity | State | Denial rate | Denied |
|---|---|---|---|
| Ambetter of North Carolina Inc. | North Carolina | 21.5% | 924,286 |
| Ambetter Health of Louisiana, Inc. | Louisiana | 19.1% | 326,106 |
| Ambetter of Magnolia Inc. | Mississippi | 16% | 1,824,195 |
That table is why the headline is only half the story: Ambetter is #7 of the 9 national brands this file carries enough volume to rank, and its own entities do not all sit where the brand does. The whole ranking is free here →
What Ambetter denies for
Top reason categories across its reporting entities: administrative (572,128) · service-excluded (419,455) · referral-required (375,369). Reason-by-reason national context is on the denial reasons pages.
The federal timeframes: 180 days from the date on the denial notice to file the internal appeal, then 4 months from the final internal denial to request independent external review. Put your date in and get the actual calendar dates, with the days remaining.
Runs entirely in your browser, the date you type is never sent to us and never stored. Open the full calculator →
Questions about Ambetter denials
What is Ambetter's denial rate?
17.7% of in-network claims, nationally, across the 3 Ambetter entities that report figures in the CMS Transparency in Coverage Public Use File, 3,074,587 of 17,373,763 claims denied. The national average across all insurers in this dataset is 18.7%. These are the brand's reporting entities in the CMS Transparency in Coverage Public Use File, in-network claims for the plans that file there, not every line of the company's business. A brand's full book (employer self-funded plans above all) is not in this file.
Which Ambetter entity denies the most?
By rate, Ambetter of North Carolina Inc. in North Carolina at 21.5%; the lowest is Ambetter of Magnolia Inc. in Mississippi at 16%. A denial rate describes an insurer's book of business, not the merits of any one claim.
Does a high Ambetter denial rate mean my claim will be denied?
No. The rate describes the book of business. What matters for you: denials are appealable, the internal appeal is free, and external review, which is binding on the plan, is overturned in 32.8% of cases nationally, yet only 5,881 were filed against 84,502,749 denials.
How do I appeal an Ambetter denial?
Two free stages, both created by federal law: the internal appeal (generally 180 days from the denial notice) and then independent external review (generally four months from the final internal denial). Your denial letter names your exact route and deadlines, it is the authority. Our free deadline calculator works them out from your letter's date.
Ambetter files through 3 separate reporting entities in this file, and they do not all behave the same way. A brand headline hides both ends of the spread. The same company can run twice the denial rate in one state as it does in another, which is why the entity table on this page matters more than the percentage at the top of it. Find your own state's row, then read that entity's page, that is the number your letter came out of.
, Andrew at Axion Labs · hello@getaxionlabs.comNo account, no email, no card. Both federal deadlines dated from your notice, and the body that decides your case at the end.
The Ambetter figures on this page are the sum of its 3 reporting entities’ own rows in that file, 3,074,587 denials out of 17,373,763 in-network claims.
Counts: CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 claims), data.healthcare.gov — US Government public domain. Rights and timeframes: 29 CFR 2560.503-1 (180 days, and your free right to the claim file) and 45 CFR 147.136 (4 months, and what qualifies), explained at HealthCare.gov. Expedited review is decided in about 72 hours under both sections.
Reading either regulation from a script rather than a browser: eCFR answers automated fetches with a challenge page, so the same two sections are mirrored as government PDFs at govinfo.gov (29 CFR 2560.503-1) and govinfo.gov (45 CFR 147.136).