Blue Cross Blue Shield of Wyoming claim denials in Wyoming: the federal figures
Blue Cross Blue Shield of Wyoming denied 10.9% of in-network claims in Wyoming — 89,175 claims out of 821,613. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Blue Cross Blue Shield of Wyoming) | 982 | 69% |
| External review (independent) | — | — |
What Blue Cross Blue Shield of Wyoming denies most
The most common denial reason recorded for Blue Cross Blue Shield of Wyoming plans in Wyoming is administrative reason. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Administrative reason | 116,376 | 41.5% |
| Service excluded from the plan | 59,205 | 21.1% |
| Member not covered | 42,780 | 15.3% |
| Benefit limit reached | 23,373 | 8.3% |
| Other reasons | 17,920 | 6.4% |
| Referral required | 14,761 | 5.3% |
| Experimental or investigational | 4,535 | 1.6% |
| Not medically necessary | 1,270 | 0.5% |
| Provider out of network | 181 | 0.1% |
What to do if Blue Cross Blue Shield of Wyoming 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. Blue Cross Blue Shield of Wyoming overturned 69% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Blue Cross Blue Shield of Wyoming. 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 Blue Cross Blue Shield of Wyoming 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 Blue Cross Blue Shield of Wyoming's denial rate high?
10.9% against a national average of 16% across the plans in this dataset. It is at or below 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 Blue Cross Blue Shield of Wyoming ignore the external decision?
No. External review decisions are binding on the plan.