Buckeye Community Health Plan claim denials in Ohio: the federal figures
Buckeye Community Health Plan denied 22.2% of in-network claims in Ohio — 504,400 claims out of 2,267,859. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Buckeye Community Health Plan) | 1,178 | 74% |
| External review (independent) | — | — |
What Buckeye Community Health Plan denies most
The most common denial reason recorded for Buckeye Community Health Plan plans in Ohio is administrative reason. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Administrative reason | 101,503 | 23.5% |
| Service excluded from the plan | 59,402 | 13.7% |
| Referral required | 58,500 | 13.5% |
| Benefit limit reached | 57,556 | 13.3% |
| Other reasons | 53,767 | 12.4% |
| Not medically necessary | 50,502 | 11.7% |
| Provider out of network | 29,701 | 6.9% |
| Member not covered | 21,489 | 5% |
What to do if Buckeye Community Health Plan 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. Buckeye Community Health Plan overturned 74% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Buckeye Community Health Plan. 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 Buckeye Community Health Plan 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 Buckeye Community Health Plan's denial rate high?
22.2% 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 Buckeye Community Health Plan ignore the external decision?
No. External review decisions are binding on the plan.