Celtic Insurance Company claim denials in Florida: the federal figures
Celtic Insurance Company denied 15% of in-network claims in Florida — 1,913,915 claims out of 12,748,561. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Celtic Insurance Company) | 4,215 | 59.2% |
| External review (independent) | — | — |
What Celtic Insurance Company denies most
The most common denial reason recorded for Celtic Insurance Company plans in Florida is administrative reason. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Administrative reason | 881,658 | 29.4% |
| Benefit limit reached | 529,477 | 17.6% |
| Service excluded from the plan | 474,746 | 15.8% |
| Other reasons | 451,089 | 15% |
| Referral required | 238,725 | 7.9% |
| Not medically necessary | 202,591 | 6.7% |
| Provider out of network | 145,636 | 4.8% |
| Member not covered | 79,003 | 2.6% |
What to do if Celtic Insurance Company 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. Celtic Insurance Company overturned 59.2% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Celtic Insurance Company. 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 Celtic Insurance Company 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 Celtic Insurance Company's denial rate high?
15% 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 Celtic Insurance Company ignore the external decision?
No. External review decisions are binding on the plan.