Anthem Ins Companies Inc(Anthem BCBS) claim denials in Indiana: the federal figures
Anthem Ins Companies Inc(Anthem BCBS) denied 27.8% of in-network claims in Indiana — 52,045 claims out of 187,370. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Anthem Ins Companies Inc(Anthem BCBS)) | 167 | 24% |
| External review (independent) | — | — |
What Anthem Ins Companies Inc(Anthem BCBS) denies most
The most common denial reason recorded for Anthem Ins Companies Inc(Anthem BCBS) plans in Indiana is service excluded from the plan. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Service excluded from the plan | 37,918 | 49.2% |
| Other reasons | 21,744 | 28.2% |
| Administrative reason | 8,866 | 11.5% |
| Provider out of network | 4,509 | 5.8% |
| Referral required | 3,755 | 4.9% |
| Not medically necessary | 244 | 0.3% |
| Benefit limit reached | 29 | 0% |
| Member not covered | 24 | 0% |
| Experimental or investigational | 13 | 0% |
What to do if Anthem Ins Companies Inc(Anthem BCBS) 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 Ins Companies Inc(Anthem BCBS) overturned 24% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Anthem Ins Companies Inc(Anthem BCBS). 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 Ins Companies Inc(Anthem BCBS) 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 Ins Companies Inc(Anthem BCBS)'s denial rate high?
27.8% 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 Anthem Ins Companies Inc(Anthem BCBS) ignore the external decision?
No. External review decisions are binding on the plan.