CareSource Ohio denied your claim. Here is your deadline.
Put in the date on your CareSource Ohio, Inc. notice and get both federal deadlines as calendar dates.
Free, for a CareSource Ohio, Inc. denial in Ohio, 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.
CareSource Ohio, Inc. denied 562,546 of 2,814,185 in-network claims in Ohio; every one of those denials had these same two dates on it. Across Ohio as a whole the insurers in this file denied 17.9% of in-network claims, 2,934,307 of them, and 35,236 were appealed.
CareSource Ohio, Inc. denied 20% of in-network claims in Ohio, 562,546 claims out of 2,814,185.
Insurance got denied, what to do next?
Those 562,546 denials are 19.2% of every in-network denial recorded in Ohio in this release, which makes CareSource Ohio, Inc. the 2nd largest source of denials of the 10 insurers reporting there. Spread across its 21 plans in the state that is about 26,788 denials per plan. 5,001 internal appeals were filed against those 562,546 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 Ohio 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: 562,546 in-network claims were denied by CareSource Ohio, Inc. in Ohio 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 10 insurers reporting a denial rate in Ohio, CareSource Ohio, Inc. is the fifth highest at 20%. The highest in the state is 26.5% and the lowest is 8.3%.
- That is 1.3 percentage points above the 18.7% national average across this dataset, and 2.1 points above the Ohio average of 17.9%.
- Behind the percentage: 2,814,185 in-network claims were processed under 21 plans in Ohio, and 562,546 of them came back denied.
- For every 10,000 claims CareSource Ohio, Inc. denied, about 89 came back as an internal appeal. The other 9,911 stopped at the letter.
- Of the internal appeals it did receive, CareSource Ohio, Inc. overturned 19.04%, 952 claims that started life as a no.
- 263 of those denials went on to independent external review, the stage whose decision the plan is required by law to accept. Nationally 32.8% of external reviews are overturned.
- Its most-recorded denial reason is administrative reason at 26.2% of its categorized denials, against 22.5% nationally, a heavier share than the country as a whole. That is the denial mix, not an outcome rate.
- CareSource Ohio, Inc. accounts for 19.2% of every in-network claim denied in Ohio in this file.
- By raw volume it is the 39th largest source of denials among the 158 insurer-state records in the file that report one.
- Put another way: one independent external review was filed for every 2,139 claims CareSource Ohio, Inc. denied in Ohio.
- After that, its second-most-recorded reason is other reasons, 129,173 claims, 16% of its categorized denials.
- Third on its own list is service excluded from the plan, 119,428 claims, 14.8% of what CareSource Ohio, Inc. categorized in Ohio. Between them the top three account for 56.9% of its categorized denials.
- Where CareSource Ohio, Inc. differs most from the national mix is member not covered: 12.8% of its categorized denials in Ohio against 6.6% across the file.
- Read the other way round: 2,251,639 of those 2,814,185 in-network claims were paid, 80% of everything CareSource Ohio, Inc. processed in Ohio.
- Spread across the 21 plans it reports in Ohio, that is about 26,788 denied claims per plan, on about 134,009 claims processed per plan.
- Its reason columns add up to 808,190 categorized rows against 562,546 denials, 143.7% 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 Ohio is not medically necessary, 178 claims, 0% of what CareSource Ohio, Inc. categorized there.
- Against the file as a whole, this one record is 0.7% of the 84,502,749 in-network claim denials reported by every issuer in it.
- Find the reason code on your denial letter. The reason CareSource Ohio, Inc. records most often in Ohio 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 CareSource Ohio, Inc. in Ohio 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. CareSource Ohio, Inc. overturned 19.04% of the internal appeals it did receive, 952 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 |
|---|---|---|
| CareSource Ohio, Inc. | 20% | , |
| Ohio average | 17.9% | +2.1 pts |
| National average (this dataset) | 18.7% | +1.3 pts |
CareSource Ohio, Inc. denies 1.3 percentage points more of its in-network claims than 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 CareSource Ohio, Inc.) | 5,001 | 19.04% |
| External review (independent) | 263 | 17.87% |
The gap nobody escalated
562,546 claims denied. 5,001 internal appeals filed. 263 reached independent external review. Nationally 32.8% 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 CareSource Ohio, Inc. letter, and by when. CareSource Ohio, Inc. overturned 19.04% of the 5,001 internal appeals its Ohio members filed against 562,546 denials, and 263 of those Ohio denials went on to the independent stage whose decision binds the plan, CareSource Ohio, Inc.'s own rows in the plan-year 2026 release of the CMS Transparency in Coverage file, read September 5, 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 60 calendar days after you receive its notice (42 CFR 422.582(b)) and Medicaid managed care the same 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 CareSource Ohio, 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 CareSource Ohio, Inc. in Ohio. One payment. No subscription. No cut of your claim.
CareSource Ohio, Inc. inside Ohio
Your denial did not happen in a national average. It happened in a state market, alongside 10 other insurers reporting into the same federal file, and these are that market's own figures.
- Across the whole of Ohio, the 11 insurers reporting in this file processed 16,409,625 in-network claims and denied 2,934,307 of them, a state denial rate of 17.9%. CareSource Ohio, Inc. is one of those 11.
- That puts Ohio 18th of 30 states by denial rate, 0.8 points below the 18.7% national average, before you get to what CareSource Ohio, Inc. did inside it.
- Ohio recorded 35,236 internal appeals against those denials: one appeal for every 83 claims the state's insurers refused. CareSource Ohio, Inc.'s own ratio is one for every 112.
- Independent external review was reached 954 times in the whole of Ohio, once for every 3,076 denials, against one in 14,369 nationally. 263 of those Ohio filings came from CareSource Ohio, Inc.'s denials.
- Of the Ohio external reviews that were filed, 215 were overturned, 22.5%. That percentage is measured on 954 reviews, which is why the count beside it matters more than the rate does when you are deciding whether to file against CareSource Ohio, Inc..
- The reason Ohio's insurers record most often is administrative reason, 951,084 claims, 26.4% of the state's categorized denials. CareSource Ohio, Inc. records the same one most often, so your letter is likely to say it too.
- The other insurers an Ohio reader could have bought from run from 26.5% (Oscar Buckeye State Insurance Corp.) to 8.3% (Community Insurance Company(Anthem BCBS)). CareSource Ohio, Inc. at 20% sits between the two.
- Put the two together and CareSource Ohio, Inc. is responsible for 19.2% of every in-network claim denied in Ohio in this release, from 17.1% of the claims the state's insurers processed.
- Every Ohio figure in this section is that state's own row in the same federal file CareSource Ohio, Inc.'s numbers above come from, CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 claims), data.healthcare.gov — US Government public domain, and the full Ohio page is free at /states/ohio.
What CareSource Ohio, Inc. denies most
The most common denial reason recorded for CareSource Ohio, Inc. plans in Ohio is administrative reason. How that denial is beaten →
| Denial reason | Claims | Share | National share |
|---|---|---|---|
| Administrative reason | 211,618 | 26.2% | 22.5% |
| Other reasons | 129,173 | 16% | 32.3% |
| Service excluded from the plan | 119,428 | 14.8% | 11.6% |
| Provider out of network | 118,510 | 14.7% | 9.8% |
| Member not covered | 103,592 | 12.8% | 6.6% |
| Referral required | 79,653 | 9.9% | 8.4% |
| Benefit limit reached | 46,038 | 5.7% | 4.2% |
| Not medically necessary | 178 | 0% | 4.6% |
The last column is each reason's share of all categorized denials nationally, so you can see where CareSource Ohio, Inc.'s mix in Ohio 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.
Runs entirely in your browser, the date you type is never sent to us and never stored. Open the full calculator →
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: CareSource Ohio, Inc. overturned 19.04% of the internal appeals it received.
Questions
Is CareSource Ohio, Inc.'s denial rate in Ohio high?
20% against a national average of 18.7% across the plans in this dataset. It is above average. A denial rate describes the insurer, not the merits of your claim.
How many people appealed a CareSource Ohio, Inc. denial in Ohio, and how many won?
5,001 internal appeals were filed against 562,546 denials, and 19.04% of them were overturned (952 claims). 263 went on to independent external review.
How does CareSource Ohio, Inc. compare with other insurers in Ohio?
Of the 10 insurers in Ohio with a reported denial rate, CareSource Ohio, Inc. ranks 5 highest at 20%. The highest in Ohio is Oscar Buckeye State Insurance Corp. at 26.5%; the lowest is Community Insurance Company(Anthem BCBS) at 8.3%.
What does CareSource Ohio, Inc. deny most often in Ohio?
Administrative reason, 211,618 claims, 26.2% of this issuer's categorized denials, against 22.5% nationally. This is the denial-reason mix; the federal file does not report overturn rates by reason.
How long do I have to appeal a CareSource Ohio, Inc. denial in Ohio?
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 Ohio, CareSource Ohio, 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 a CareSource Ohio, Inc. denial in Ohio cost anything?
The internal appeal to CareSource Ohio, 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 Ohio can be charged more than that to file one.
Can CareSource Ohio, Inc. ignore an external review decision in Ohio?
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 263 external reviews recorded against 562,546 CareSource Ohio, Inc. denials in Ohio the striking number on this page.
CareSource Ohio, Inc. sits at 20% in Ohio against 18.7% nationally, and that is the whole of what this page can honestly tell you about your own claim. I am 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 me and I will correct the page.
, Andrew at Axion Labs · hello@getaxionlabs.comEverything you need for your CareSource Ohio, Inc. appeal in Ohio: your two deadlines, the argument that fits your denial reason, the letters, the clinician brief, 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 CareSource Ohio, Inc. figures on this page, the 20% denial rate, the 562,546 denials and the 263 external reviews, are this issuer’s own reported rows in that file.
Counts: CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 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).