Anthem Blue Cross and Blue Shield claim denials in Georgia: the federal figures
Anthem Blue Cross and Blue Shield denied 23.7% of in-network claims in Georgia — 904,058 claims out of 3,813,700. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Anthem Blue Cross and Blue Shield) | 569 | 16.7% |
| External review (independent) | — | — |
What Anthem Blue Cross and Blue Shield denies most
The most common denial reason recorded for Anthem Blue Cross and Blue Shield plans in Georgia is service excluded from the plan. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Service excluded from the plan | 444,767 | 41.2% |
| Other reasons | 338,769 | 31.4% |
| Administrative reason | 107,963 | 10% |
| Referral required | 94,685 | 8.8% |
| Provider out of network | 78,215 | 7.3% |
| Not medically necessary | 8,114 | 0.8% |
| Benefit limit reached | 4,422 | 0.4% |
| Member not covered | 1,421 | 0.1% |
| Experimental or investigational | 11 | 0% |
What to do if Anthem Blue Cross and Blue Shield 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. Anthem Blue Cross and Blue Shield overturned 16.7% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Anthem Blue Cross and Blue Shield. 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 Anthem Blue Cross and Blue Shield 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 Anthem Blue Cross and Blue Shield's denial rate high?
23.7% 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 Anthem Blue Cross and Blue Shield ignore the external decision?
No. External review decisions are binding on the plan.