Oscar Health denied it. Here is their form, and your deadline.
Put in the date on your Oscar Health notice and get both federal deadlines as calendar dates.
Free, for an Oscar Health 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.
Oscar Health'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?
Further down this page, after the free steps: the paid next step.
If Oscar Health 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: 2,075,838 in-network claims were denied by Oscar Health 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 Oscar Health entity that decided it, not just the brand, and with 12 of them reporting into this file, that name is what tells you which row on this page is yours.
- Ask Oscar Health 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. 2,075,838 claims were denied across Oscar Health'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.
After these free steps, the paid Appeal Kit is the same clock dated from your Oscar Health notice, with the claim-file and external-review requests written out.
Every Oscar Health entity in the file
| Entity | State | Denial rate | Denied |
|---|---|---|---|
| Oscar Buckeye State Insurance Corp. | Ohio | 18.8% | 266,043 |
| Oscar Insurance Company | Tennessee | 18.7% | 500,557 |
| Oscar Insurance Company | Missouri | 18.4% | 64,953 |
| Oscar Insurance Company | Michigan | 18.2% | 23,592 |
| Oscar Insurance Company | Kansas | 17.9% | 65,133 |
| Oscar Health Plan, Inc. | Arizona | 17.8% | 69,003 |
| Oscar Insurance Company | Iowa | 17.5% | 122,005 |
| Oscar Insurance Company | Nebraska | 17.1% | 15,381 |
| Oscar Insurance Company | Oklahoma | 16% | 18,534 |
| Oscar Insurance Company | Texas | 15.3% | 829,696 |
| Oscar Insurance Corporation of Ohio | Ohio | 14.4% | 75,554 |
| Oscar Health Plan of North Carolina, Inc | North Carolina | 12.8% | 25,387 |
| Oscar Insurance Company | Alabama | not reported | not reported |
| Oscar Health Maintenance Organization of Florida | Florida | not reported | not reported |
| Oscar Health Plan, Inc. | Mississippi | not reported | not reported |
| Oscar Health Plan, Inc. | South Carolina | not reported | not reported |
That table is why the headline is only half the story: Oscar Health is #4 of the 5 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 →
Oscar Health denied claim: the two dates that decide it
If Oscar Health denied a claim of yours, the percentage above is not the thing to act on. Two dates are: generally 180 days from the date on the denial notice to file the internal appeal, then generally four months from the final internal denial to ask for the independent external review whose decision binds the plan. The tool at the top of this page works both out from your own notice, free. The rules are 29 CFR 2560.503-1 and 45 CFR 147.136.
What Oscar Health denies for
Top reason categories across its reporting entities: administrative (1,113,803) · out-of-network (342,739) · other (264,763). 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 Oscar Health denials
What is Oscar Health's denial rate?
16.8% of in-network claims, nationally, across the 12 Oscar Health entities that report figures in the CMS Transparency in Coverage Public Use File, 2,075,838 of 12,378,781 claims denied. The national average across all insurers in this dataset is 15.7%. 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 Oscar Health entity denies the most?
By rate, Oscar Buckeye State Insurance Corp. in Ohio at 18.8%; the lowest is Oscar Health Plan of North Carolina, Inc in North Carolina at 12.8%. A denial rate describes an insurer's book of business, not the merits of any one claim.
Does a high Oscar Health 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 22.2% (1,092 of 4,918; interval 22.2-23.8% for counts CMS withheld; 32.6% without SelectHealth) of cases nationally, yet only 4,918 were filed against 83,907,852 denials.
How do I appeal an Oscar Health 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.
Oscar Health files through 12 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.
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 Oscar Health figures on this page are the sum of its 12 reporting entities’ own rows in that file, 2,075,838 denials out of 12,378,781 in-network claims.
Counts: CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 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).