Absolute Total Care, Inc claim denials in South Carolina: the federal figures
Absolute Total Care, Inc denied 17.8% of in-network claims in South Carolina — 269,843 claims out of 1,518,301. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Absolute Total Care, Inc) | 641 | 63.2% |
| External review (independent) | — | — |
What Absolute Total Care, Inc denies most
The most common denial reason recorded for Absolute Total Care, Inc plans in South Carolina is administrative reason. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Administrative reason | 127,727 | 28.9% |
| Service excluded from the plan | 74,971 | 16.9% |
| Referral required | 59,997 | 13.6% |
| Not medically necessary | 52,186 | 11.8% |
| Benefit limit reached | 48,016 | 10.9% |
| Other reasons | 42,204 | 9.5% |
| Provider out of network | 23,028 | 5.2% |
| Member not covered | 14,195 | 3.2% |
What to do if Absolute Total Care, Inc denied your claim
- Get the reason in writing. The denial notice must state the specific reason and the plan provision behind it. If it does not, request it — you are entitled to it free of charge.
- File the internal appeal. Generally within 180 days of the denial notice. Absolute Total Care, Inc overturned 63.2% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Absolute Total Care, Inc. Generally you have 4 months from the final internal denial. This is the step nearly everyone skips.
- Ask for expedited review if waiting would seriously jeopardise your health. That timeline is days, not months.
Everything you need for your Absolute Total Care, Inc appeal: your two deadlines, the argument that fits your denial reason, an evidence checklist, and the external review request. Opens on screen the moment you pay.
Questions
Is Absolute Total Care, Inc's denial rate high?
17.8% against a national average of 16% across the plans in this dataset. It is above average. A denial rate describes the insurer, not the merits of your claim.
Does appealing cost anything?
The internal appeal is free. External review is free under the HHS-administered federal process; where an issuer uses a contracted independent review organization or a state process, any fee is capped at $25.
Can Absolute Total Care, Inc ignore the external decision?
No. External review decisions are binding on the plan.