Celtic denied your claim in Texas. Here is your deadline.
Put in the date on your Celtic Insurance Company notice and get both federal deadlines as calendar dates.
Free, for a Celtic Insurance Company denial in Texas, 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.
Celtic Insurance Company denied 2,698,996 of 27,614,462 in-network claims in Texas; every one of those denials had these same two dates on it. Across Texas as a whole the insurers in this file denied 17.3% of in-network claims, 24,184,622 of them, and 89,989 were appealed.
Or let the $29 Appeal Kit date each step and write the claim-file and external-review requests.
Celtic Insurance Company denied 9.8% of in-network claims in Texas, 2,698,996 claims out of 27,614,462.
Further down this page, after the free steps: the paid next step.
Insurance got denied, what to do next?
Those 2,698,996 denials are 11.2% of every in-network denial recorded in Texas in this release, which makes Celtic Insurance Company the 2nd largest source of denials of the 13 insurers reporting there. Spread across its 17 plans in the state that is about 158,764 denials per plan. 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 Texas 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: 2,698,996 in-network claims were denied by Celtic Insurance Company in Texas 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 13 insurers reporting a denial rate in Texas, Celtic Insurance Company is the 13th highest at 9.8%. The highest in the state is 36.8% and the lowest is 9.8%.
- That is 5.9 percentage points below the 15.7% national average across this dataset, and 7.5 points below the Texas average of 17.3%.
- Behind the percentage: 27,614,462 in-network claims were processed under 17 plans in Texas, and 2,698,996 of them came back denied.
- 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 service excluded from the plan at 18.6% of its categorized denials, against 13.4% nationally, a heavier share than the country as a whole. That is the denial mix, not an outcome rate.
- In Texas, Celtic Insurance Company reported 9.8%, and the same company files in 5 other states in this file, where the rate is not the same in any of them: 13.5% in Oklahoma, 11.5% in Tennessee, 11.4% in Kansas, down to 10.9% in Missouri. Which state the plan was bought in moves the odds more than the brand on the card does.
- Celtic Insurance Company accounts for 11.2% of every in-network claim denied in Texas in this file.
- By raw volume it is the seventh largest source of denials among the 135 insurer-state records in the file that report one.
- After that, its second-most-recorded reason is referral required, 832,150 claims, 17.4% of its categorized denials.
- Third on its own list is not medically necessary, 800,203 claims, 16.7% of what Celtic Insurance Company categorized in Texas. Between them the top three account for 52.7% of its categorized denials.
- Where Celtic Insurance Company differs most from the national mix is not medically necessary: 16.7% of its categorized denials in Texas against 5.5% across the file.
- Read the other way round: 24,915,466 of those 27,614,462 in-network claims were paid, 90.2% of everything Celtic Insurance Company processed in Texas.
- Spread across the 17 plans it reports in Texas, that is about 158,764 denied claims per plan, on about 1,624,380 claims processed per plan.
- Its reason columns add up to 4,783,209 categorized rows against 2,698,996 denials, 177.2% 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 Texas is member not covered, 164,461 claims, 3.4% of what Celtic Insurance Company categorized there.
- Against the file as a whole, this one record is 3.2% 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 Celtic Insurance Company records most often in Texas is service excluded from the plan, 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 Celtic Insurance Company in Texas 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. 2,698,996 claims were denied here in a single year and not one was escalated; the deadline is what decides whether anyone reads the argument.
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 |
|---|---|---|
| Celtic Insurance Company | 9.8% | , |
| Texas average | 17.3% | -7.5 pts |
| National average (this dataset) | 15.7% | -5.9 pts |
Celtic Insurance Company 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 Celtic Insurance Company) | not reported | not reported |
| External review (independent) | 0 | not reported |
The gap nobody escalated
2,698,996 claims denied. not reported 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 Celtic Insurance Company letter, and by when. Celtic Insurance Company recorded 2,698,996 denials in Texas and no separately reported appeal outcome, so this page cannot tell you how its Texas appeals went, the Celtic Insurance Company 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 Celtic Insurance Company 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 Celtic Insurance Company in Texas. One payment. No subscription. No cut of your claim.
Celtic Insurance Company inside Texas
Your denial did not happen in a national average. It happened in a state market, alongside 15 other insurers reporting into the same federal file, and these are that market's own figures.
- Across the whole of Texas, the 16 insurers reporting in this file processed 139,454,274 in-network claims and denied 24,184,622 of them, a state denial rate of 17.3%. Celtic Insurance Company is one of those 16.
- That puts Texas 11th of 29 states by denial rate, 1.6 points above the 15.7% national average, before you get to what Celtic Insurance Company did inside it.
- Texas recorded 89,989 internal appeals against those denials: one appeal for every 269 claims the state's insurers refused.
- Independent external review was reached 158 times in the whole of Texas, once for every 153,067 denials, against one in 17,061 nationally. None of them came from Celtic Insurance Company's denials.
- Of the Texas external reviews that were filed, 50 were overturned, 31.6%. That percentage is measured on 158 reviews, which is why the count beside it matters more than the rate does when you are deciding whether to file against Celtic Insurance Company.
- The reason Texas's insurers record most often is other reasons, 13,485,994 claims, 35.5% of the state's categorized denials. Celtic Insurance Company records service excluded from the plan most often instead, which is the argument your letter will need to answer.
- The other insurers a Texas reader could have bought from run from 36.8% (Imperial Insurance Companies, Inc.) to 11.1% (CHRISTUS Health Plan). Celtic Insurance Company at 9.8% sits below all of them.
- Put the two together and Celtic Insurance Company is responsible for 11.2% of every in-network claim denied in Texas in this release, from 19.8% of the claims the state's insurers processed.
- Every Texas figure in this section is that state's own row in the same federal file Celtic Insurance Company'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 Texas page is free at /states/texas.
What Celtic Insurance Company denies most
The most common denial reason recorded for Celtic Insurance Company plans in Texas is service excluded from the plan. How that denial is beaten →
| Denial reason | Claims | Share | National share |
|---|---|---|---|
| Service excluded from the plan | 889,060 | 18.6% | 13.4% |
| Referral required | 832,150 | 17.4% | 9.6% |
| Not medically necessary | 800,203 | 16.7% | 5.5% |
| Administrative reason | 768,582 | 16.1% | 17.2% |
| Other reasons | 645,298 | 13.5% | 32.4% |
| Benefit limit reached | 392,210 | 8.2% | 4.9% |
| Provider out of network | 291,245 | 6.1% | 9% |
| Member not covered | 164,461 | 3.4% | 7.9% |
The last column is each reason's share of all categorized denials nationally, so you can see where Celtic Insurance Company's mix in Texas 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.
Who appeals what at Ambetter (Centene)
Centene's Ambetter runs as state-branded plans (Superior, Sunshine, Peach State and others), the process is published per state. Its sharpest rule: claim-payment disagreements are NOT appeals at all; they go through a separate claim dispute process first. From Ambetter (Centene)'s published pages, written for health care providers (Texas plan page) and members; each is listed below with its date. It is brand-level and applies to Celtic Insurance Company in Texas the same as to every other Ambetter (Centene) entity in the file.
| Dispute | Route |
|---|---|
| Medical necessity denial | Appeal, 180 calendar days |
| Claims payment disagreement | NOT an appeal: 'the provider must follow the process for claim reconsideration or claim dispute … prior to filing a Complaint.' |
Operational facts from the same policy
- Medical-necessity appeal window: 180 calendar days
- Standard resolution clock: 30 calendar days
- Expedited appeal clock: 1 working day / 72 hours from complete information
- Submission (Texas plan): Complaints Department, 5900 E. Ben White Blvd., Austin, TX 78741 · Fax 1-866-683-5369 , Texas plan's address — each state plan publishes its own.
- Member appeal window: 180 calendar days, orally or in writing , Member-side confirmation of the 180-day window; also confirms the 30-day resolution clock ('shall not exceed 30 calendar days from the date Ambetter receives the appeal') and the expedited 1-working-day / 72-hour-written clock.
- Member APPEALS address differs from the complaints address: Appeals Department, 5900 E Ben White Blvd., Austin, TX 78741 · Fax 1-866-918-2266 , Same street address as the Complaints Department but a different fax: appeals go to 1-866-918-2266, grievances/complaints to 1-866-683-5369. The plan page's complaints fax is not the appeals fax.
- External review via MAXIMUS: four months from the final internal decision; standard decided ≤45 days, expedited ≤72 hours , Route: Externalappeal.com, fax 1-888-866-6190, or mail to MAXIMUS Federal Services, 3750 Monroe Avenue, Suite 705, Pittsford, NY 14534. Matches the federal 4-month right this site publishes.
Sources: Ambetter (Centene), "Grievance and Appeals (Ambetter from Superior HealthPlan, Texas)", quoted, not paraphrased; audience: health care providers (Texas plan page); checked 2026-11-05. Ambetter (Centene), "Appeals and Grievances Guide (Ambetter from Superior HealthPlan, Texas — member guide, last updated December 2024)", quoted, not paraphrased; audience: members; checked 2026-11-05. Brand-level policy, applied here because Celtic Insurance Company is an Ambetter (Centene) entity. Your own denial letter and plan documents govern your specific case.
Questions
Is Celtic Insurance Company's denial rate in Texas high?
9.8% 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 a Celtic Insurance Company denial in Texas, and how many won?
Appeal volumes were not separately reported for Celtic Insurance Company in Texas. Across Texas as a whole 89,989 internal appeals were filed against 24,184,622 denials, one for every 269 refused, and that is the state figure, not this company's. Nationally, 26.8% of internal appeals and 22.2% of external reviews are overturned.
How does Celtic Insurance Company compare with other insurers in Texas?
Of the 13 insurers in Texas with a reported denial rate, Celtic Insurance Company ranks 13 highest at 9.8%. The highest in Texas is Imperial Insurance Companies, Inc. at 36.8%; the lowest is Celtic Insurance Company at 9.8%.
What does Celtic Insurance Company deny most often in Texas?
Service excluded from the plan, 889,060 claims, 18.6% of this issuer's categorized denials, against 13.4% 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 Celtic Insurance Company denial in Texas?
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 Texas, Celtic Insurance Company 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 Celtic Insurance Company denial in Texas cost anything?
The internal appeal to Celtic Insurance Company 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 Texas can be charged more than that to file one.
Can Celtic Insurance Company ignore an external review decision in Texas?
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 2,698,996 Celtic Insurance Company denials in Texas the striking number on this page.
The line on this page we would read twice is the one that says not one of Celtic Insurance Company's 2,698,996 denials in Texas 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 Celtic Insurance Company appeal in Texas: 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 Celtic Insurance Company figures on this page, the 9.8% denial rate, the 2,698,996 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).