Avera denied your claim in South Dakota. Here is your deadline.
Put in the date on your Avera Health Plans, Inc. notice and get both federal deadlines as calendar dates.
Free, for an Avera Health Plans, Inc. denial in South Dakota, 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.
Avera Health Plans, Inc. denied 17,773 of 504,170 in-network claims in South Dakota; every one of those denials had these same two dates on it. Across South Dakota as a whole the insurers in this file denied 5.9% of in-network claims, 95,138 of them, and 272 were appealed.
Or let the $29 Appeal Kit date each step and write the claim-file and external-review requests.
Avera Health Plans, Inc. denied 3.5% of in-network claims in South Dakota, 17,773 claims out of 504,170.
Further down this page, after the free steps: the paid next step.
Insurance got denied, what to do next?
Those 17,773 denials are 18.7% of every in-network denial recorded in South Dakota in this release, which makes Avera Health Plans, Inc. the 3rd largest source of denials of the 3 insurers reporting there. Spread across its 30 plans in the state that is about 592 denials per plan. 72 internal appeals were filed against those 17,773 denials. Every one of those denials carried the same two dates the tool at the top of this page works out.
Two dates matter more than anything else on this page, and they run the same in South Dakota as everywhere else. 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: 17,773 in-network claims were denied by Avera Health Plans, Inc. in South Dakota 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.
- Of the 3 insurers reporting a denial rate in South Dakota, Avera Health Plans, Inc. is the second highest at 3.5%. The highest in the state is 15.4% and the lowest is 2.5%.
- That is 12.2 percentage points below the 15.7% national average across this dataset, and 2.4 points below the South Dakota average of 5.9%.
- Behind the percentage: 504,170 in-network claims were processed under 30 plans in South Dakota, and 17,773 of them came back denied.
- For every 10,000 claims Avera Health Plans, Inc. denied, about 41 came back as an internal appeal. The other 9,959 stopped at the letter.
- Of the internal appeals it did receive, Avera Health Plans, Inc. overturned 69.44%, 50 claims that started life as a no.
- Not one of those denials reached independent external review, the stage whose decision the plan is required by law to accept, and where nationally 22.2% (1,092 of 4,918; interval 22.2-23.8% for counts CMS withheld; 32.6% without SelectHealth) are overturned.
- Its most-recorded denial reason is administrative reason at 52.6% of its categorized denials, against 17.2% nationally, a heavier share than the country as a whole. That is the denial mix, not an outcome rate.
- Avera Health Plans, Inc. accounts for 18.7% of every in-network claim denied in South Dakota in this file.
- By raw volume it is the 121th largest source of denials among the 135 insurer-state records in the file that report one.
- After that, its second-most-recorded reason is service excluded from the plan, 1,636 claims, 25.4% of its categorized denials.
- Third on its own list is provider out of network, 1,361 claims, 21.1% of what Avera Health Plans, Inc. categorized in South Dakota. Between them the top three account for 99.1% of its categorized denials.
- Where Avera Health Plans, Inc. differs most from the national mix is administrative reason: 52.6% of its categorized denials in South Dakota against 17.2% across the file.
- Read the other way round: 486,397 of those 504,170 in-network claims were paid, 96.5% of everything Avera Health Plans, Inc. processed in South Dakota.
- Spread across the 30 plans it reports in South Dakota, that is about 592 denied claims per plan, on about 16,806 claims processed per plan.
- Its reason columns add up to 6,448 categorized rows against 17,773 denials, 36.3% of them, and every reason share on this page is a share of that first figure rather than of the second.
- Its smallest recorded category in South Dakota is referral required, 17 claims, 0.3% of what Avera Health Plans, Inc. categorized there.
- Against the file as a whole, this one record is 0% of the 83,907,852 in-network claim denials reported by every issuer in it.
- Find the reason code on your denial letter. The reason Avera Health Plans, Inc. records most often in South Dakota is administrative reason, but yours may be one of the other 8, copy the exact wording and code off your own letter tonight, because that sentence is what your appeal has to answer.
- Ask Avera Health Plans, Inc. in South Dakota 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. Avera Health Plans, Inc. overturned 69.44% of the internal appeals it did receive, 50 claims, so the stage you are about to start is not decorative.
None of those three steps costs anything. Anyone charging you to do them is selling you something you can do yourself in twenty minutes.
How that compares
| Denial rate | Rate | Difference |
|---|---|---|
| Avera Health Plans, Inc. | 3.5% | , |
| South Dakota average | 5.9% | -2.4 pts |
| National average (this dataset) | 15.7% | -12.2 pts |
Avera Health Plans, Inc. sits at or below the national average across this dataset. A denial rate is a property of the insurer's book of business, coding practice, plan design, the population it covers, not evidence about the merits of any one claim, including yours.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Avera Health Plans, Inc.) | 72 | 69.44% |
| External review (independent) | 0 | not reported |
The gap nobody escalated
17,773 claims denied. 72 internal appeals filed. None reached independent external review. Nationally 22.2% (1,092 of 4,918; interval 22.2-23.8% for counts CMS withheld; 32.6% without SelectHealth) of external reviews are overturned and the decision binds the plan.
That is arithmetic from the reported figures, not a prediction: nobody can say what those specific denials would have done at review, because they never got there. What the numbers do establish is that the binding stage was almost entirely unused here.
What that record means for your own Avera Health Plans, Inc. letter, and by when. Avera Health Plans, Inc. overturned 69.44% of the 72 internal appeals its South Dakota members filed against 17,773 denials, and not one of those South Dakota denials went on to the independent stage whose decision binds the plan, Avera Health Plans, Inc.'s own rows in the plan-year 2027 release of the CMS Transparency in Coverage file, read November 4, 2026 (data.healthcare.gov). Whichever way that lands, nobody files the appeal for you, and the filing runs on a clock set by which plan you hold: an employer or Marketplace plan gives you at least 180 days from the denial notice to file the internal appeal (29 CFR 2560.503-1(h)(3)(i), carried onto individual-market coverage by 45 CFR 147.136(b)(3)(i)), while Medicare Advantage gives you 65 calendar days from the date of its notice (CMS, 42 CFR 422.582(b)) and Medicaid managed care 60 calendar days from the date on the notice (42 CFR 438.402(c)(2)(ii)), both stages free, and the three steps above are the whole of what to do tonight, so take the date printed on your Avera Health Plans, Inc. notice and file well inside whichever of those windows is yours. The free steps are above; the $29 kit is the same clock with the letters pre-filled for Avera Health Plans, Inc. in South Dakota. One payment. No subscription. No cut of your claim.
Avera Health Plans, Inc. inside South Dakota
Your denial did not happen in a national average. It happened in a state market, alongside 2 other insurers reporting into the same federal file, and these are that market's own figures.
- Across the whole of South Dakota, the 3 insurers reporting in this file processed 1,615,279 in-network claims and denied 95,138 of them, a state denial rate of 5.9%. Avera Health Plans, Inc. is one of those 3.
- That puts South Dakota 29th of 29 states by denial rate, 9.8 points below the 15.7% national average, before you get to what Avera Health Plans, Inc. did inside it.
- South Dakota recorded 272 internal appeals against those denials: one appeal for every 350 claims the state's insurers refused. Avera Health Plans, Inc.'s own ratio is one for every 247.
- Not one denial in South Dakota reached independent external review in the reported year, not Avera Health Plans, Inc.'s and not any other insurer's in the state. That is the stage whose decision the plan is required by law to accept.
- The reason South Dakota's insurers record most often is other reasons, 52,665 claims, 47.9% of the state's categorized denials. Avera Health Plans, Inc. records administrative reason most often instead, which is the argument your letter will need to answer.
- The other insurers a South Dakota reader could have bought from run from 15.4% (Wellmark of South Dakota) to 2.5% (Sanford Health Plan). Avera Health Plans, Inc. at 3.5% sits between the two.
- Put the two together and Avera Health Plans, Inc. is responsible for 18.7% of every in-network claim denied in South Dakota in this release, from 31.2% of the claims the state's insurers processed.
- Every South Dakota figure in this section is that state's own row in the same federal file Avera Health Plans, Inc.'s numbers above come from, CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 claims), data.healthcare.gov — US Government public domain, and the full South Dakota page is free at /states/south-dakota.
What Avera Health Plans, Inc. denies most
The most common denial reason recorded for Avera Health Plans, Inc. plans in South Dakota is administrative reason. How that denial is beaten →
| Denial reason | Claims | Share | National share |
|---|---|---|---|
| Administrative reason | 3,391 | 52.6% | 17.2% |
| Service excluded from the plan | 1,636 | 25.4% | 13.4% |
| Provider out of network | 1,361 | 21.1% | 9% |
| Other reasons | 43 | 0.7% | 32.4% |
| Referral required | 17 | 0.3% | 9.6% |
The last column is each reason's share of all categorized denials nationally, so you can see where Avera Health Plans, Inc.'s mix in South Dakota differs from everyone else's. This is denial mix, not overturn rate by reason, the federal file does not report appeal outcomes broken down by denial reason, and we do not imply otherwise.
Put the date from your notice in and get the two calendar dates, with the days remaining.
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Or let the $29 Appeal Kit date each step and write the claim-file and external-review requests.
The three steps at the top of this page are the whole of what you have to do tonight. The longer version, what the internal appeal has to contain, how the independent stage works, and how to ask for expedited handling when waiting would seriously jeopardize your health, is published free here. For what it is worth on this page specifically: Avera Health Plans, Inc. overturned 69.44% of the internal appeals it received.
Questions
Is Avera Health Plans, Inc.'s denial rate in South Dakota high?
3.5% against a national average of 15.7% across the plans in this dataset. It is at or below average. A denial rate describes the insurer, not the merits of your claim.
How many people appealed an Avera Health Plans, Inc. denial in South Dakota, and how many won?
72 internal appeals were filed against 17,773 denials, and 69.44% of them were overturned (50 claims). Not one went on to independent external review, the stage whose decision is binding on the plan.
How does Avera Health Plans, Inc. compare with other insurers in South Dakota?
Of the 3 insurers in South Dakota with a reported denial rate, Avera Health Plans, Inc. ranks 2 highest at 3.5%. The highest in South Dakota is Wellmark of South Dakota at 15.4%; the lowest is Sanford Health Plan at 2.5%.
What does Avera Health Plans, Inc. deny most often in South Dakota?
Administrative reason, 3,391 claims, 52.6% of this issuer's categorized denials, against 17.2% nationally. This is the denial-reason mix; the federal file does not report overturn rates by reason.
How long do I have to appeal an Avera Health Plans, Inc. denial in South Dakota?
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 request independent external review. Expedited review, decided in about 72 hours, is available where delay would seriously jeopardize your health. Those timeframes are federal, so they are identical for every insurer reporting in South Dakota, Avera Health Plans, Inc. included, what varies by state is who runs the independent review at the end. Your own denial letter states the deadlines that govern your plan; that letter is the authority.
Does appealing an Avera Health Plans, Inc. denial in South Dakota cost anything?
The internal appeal to Avera Health Plans, Inc. 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 per review. Nobody in South Dakota can be charged more than that to file one.
Can Avera Health Plans, Inc. ignore an external review decision in South Dakota?
No, and that is the whole point of the stage. External review decisions are binding on the plan by law, which is what makes the zero external reviews recorded against 17,773 Avera Health Plans, Inc. denials in South Dakota the striking number on this page.
The line on this page we would read twice is the one that says not one of Avera Health Plans, Inc.'s 17,773 denials in South Dakota reached independent review. We are not going to tell you that you will win. This page prints the insurer's own reported numbers whichever way they fall. If what it says does not match the letter in your hand, write to us and we will correct the page.
Axion Labs · hello@getaxionlabs.comEverything you need for your Avera Health Plans, Inc. appeal in South Dakota: your two deadlines, the argument that fits your denial reason, the letters, a brief for your doctor on what the reviewer checks, and the external review request. One payment. No subscription. No cut of your claim. Opens on screen the moment you pay. 14-day refund, no questions, one email to hello@getaxionlabs.com.
The Avera Health Plans, Inc. figures on this page, the 3.5% denial rate, the 17,773 denials and the 0 external reviews, are this issuer’s own reported rows in that file.
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).