---
title: "Celtic TX appeal form and deadline"
url: "https://denialfacts.com/insurers/celtic-insurance-company--tx"
publisher: "Axion Labs — Denial Facts"
checked: "2026-11-04"
dataset_fixity: "sha256-cda2f9b89c8dde2a74989a35dbe7c0d08ff35dac5456484dc1c03c1b181a67b6"
---

# Celtic denied your claim in Texas. Here is your deadline.

Denied by Celtic in Texas? Your two federal appeal deadlines dated from your notice, a free letter, and its 9.8% denial rate in the federal file.

## Figures

| Figure | Value |
| --- | --- |
| In-network denial rate | 9.8% |
| Claims denied | 2,698,996 |
| Plans in Texas | 17 |
| Internal appeals filed | not reported |
| Internal overturn rate | not reported |
| In-network claims received | 27,614,462 |
| External reviews filed | 0 |
| External overturn rate | not reported |
| National denial rate | 15.7% |

## External-review route

**Federal process.** CMS lists Texas among the states without an external review process meeting the federal standards. Insurers there must use either the HHS-administered federal process or an independent review organization under contract. This route is the one for insured plans, Marketplace, individual, and employer plans where an insurance company carries the risk. If your coverage is through a job and the employer pays the claims itself (a self-funded or self-insured plan, which is 63% of covered workers), the state process does not apply to you whatever your state operates, and your external review goes through the federal process instead. Your denial letter names your route; if it does not, ask your plan in writing whether the plan is self-funded.

## Denials by reason

| Reason | Claims | Share of this insurer's categorized denials |
| --- | --- | --- |
| Service excluded from the plan | 889,060 | 18.6% |
| Referral required | 832,150 | 17.4% |
| Not medically necessary | 800,203 | 16.7% |
| Administrative reason | 768,582 | 16.1% |
| Other reasons | 645,298 | 13.5% |
| Benefit limit reached | 392,210 | 8.2% |
| Provider out of network | 291,245 | 6.1% |
| Member not covered | 164,461 | 3.4% |

## Celtic in Texas, at the top of the page

Texas

Your two dates, free

Date on your denial notice

Who pays your claims?

A job, an insurance company pays the claims

A job, my employer pays the claims itself (self-funded)

A job, I do not know which

Marketplace / individual plan I bought myself

Medicare, Medicaid, TRICARE, VA or IHS

Which state?

The reason your letter gives

I'm not sure, I'll paste the sentence later

Not medically necessary
Provider out of network
Service excluded from the plan
Experimental or investigational
Referral required
Benefit limit reached
Member not covered
Administrative reason
Other reasons

Show my two dates, free

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](/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.

By [Axion Labs](/about) · August 19, 2026, updated November 4, 2026

Further down this page, after the free steps: the paid next step .

Insurance got denied, what to do next?

We hear this most. [r/HealthInsurance, thread title](https://www.reddit.com/r/HealthInsurance/comments/1rdxwvi/insurance_got_denied_what_to_do_next/) , read September 3, 2026.

The number nobody else publishes. Not one of the 2,698,996 denials Celtic Insurance Company issued in Texas reached the independent review its own staff do not decide, an explicit zero in this insurer's own filed row, not an absence. The stage was there the whole time and it binds the plan. Nationally 22.2% (1,092 of 4,918; interval 22.2-23.8% for counts CMS withheld; 32.6% without SelectHealth) of the reviews that got there were overturned.

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.

The clock your letter has to describe, in actual dates

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](https://www.ecfr.gov/current/title-29/section-2560.503-1) ( [PDF](https://www.govinfo.gov/content/pkg/CFR-2024-title29-vol9/pdf/CFR-2024-title29-vol9-sec2560-503-1.pdf) ) and [45 CFR 147.136](https://www.ecfr.gov/current/title-45/section-147.136) ( [PDF](https://www.govinfo.gov/content/pkg/CFR-2024-title45-vol2/pdf/CFR-2024-title45-vol2-sec147-136.pdf) ), in plain English at [HealthCare.gov](https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/) , 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.

Notice for Celtic Insurance Company in Texas, there is a deadline in this one. CMS says the HHS-Administered Federal External Review Process reopened on July 31, 2026. If your plan uses that process and you could not file between July 1, 2026 and August 3, 2026, CMS says you may be eligible for an extension and have until October 2, 2026 to request external review. If you filed before July 1, 2026 you do not need to resubmit; if you already have a final decision through the federal process, the extension does not apply to you. HealthCare.gov names one group this state-by-state page cannot show you: it says the extension may reach you if you have a state or local government plan in any state , not only in the states whose insurers use the federal process. Both pages were read at source on September 5, 2026 and this is what they said that day, [the CCIIO external appeals page](https://www.cms.gov/CCIIO/Resources/Files/external_appeals) and [HealthCare.gov on external review](https://www.healthcare.gov/appeal-insurance-company-decision/external-review/) . Read them again before you rely on this: it is a live deadline and it has moved once already. Texas is one of the states CMS lists as using the federal process, so this applies to an insured plan bought there. If your plan uses a contracted independent review organization instead, none of this affects you.

Data verified November 4, 2026 · CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 claims), data.healthcare.gov — US Government public domain

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](/denial-reasons/referral-required) , 832,150 claims, 17.4% of its categorized denials.

- Third on its own list is [not medically necessary](/denial-reasons/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](/denial-reasons/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](/denial-reasons/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.

What to do tonight

- 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](https://www.ecfr.gov/current/title-29/section-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.

9.8%

In-network denial rate

2,698,996

Claims denied

17

Plans in Texas

not reported

Internal appeals filed

not reported

Internal overturn rate

## 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 |

Read that again: Celtic Insurance Company denied 2,698,996 claims in Texas, and not one went to independent external review. External review is free to you and the insurer must follow the decision.

## 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](https://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)](https://www.govinfo.gov/content/pkg/CFR-2024-title29-vol9/pdf/CFR-2024-title29-vol9-sec2560-503-1.pdf) , carried onto individual-market coverage by [45 CFR 147.136(b)(3)(i)](https://www.govinfo.gov/content/pkg/CFR-2024-title45-vol2/pdf/CFR-2024-title45-vol2-sec147-136.pdf) ), while Medicare Advantage gives you 65 calendar days from the date of its notice ( [CMS](https://www.cms.gov/medicare/appeals-grievances/managed-care/reconsideration-advantage-health-plan-part-c) , [42 CFR 422.582(b)](https://www.ecfr.gov/current/title-42/section-422.582) ) and Medicaid managed care 60 calendar days from the date on the notice ( [42 CFR 438.402(c)(2)(ii)](https://www.ecfr.gov/current/title-42/section-438.402) ), 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](/appeal-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](/denial-reasons/other) , 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.](/insurers/imperial-insurance-companies-inc--tx) ) to 11.1% ( [CHRISTUS Health Plan](/insurers/christus-health-plan--tx) ). 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](https://data.healthcare.gov/) , and the full Texas page is free at [/states/texas](/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-reasons/service-excluded)

| 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.

Work out your two deadlines

Put the date from your notice in and get the two calendar dates, with the days remaining.

Date on your denial notice

Which denial is this?

First denial (I have not appealed yet)

Final internal denial (my appeal was refused)

Show my deadlines

Runs entirely in your browser, the date you type is never sent to us and never stored. [Open the full calculator →](/appeal-deadline-calculator)

Or let the [$29 Appeal Kit](/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](/how-to-appeal) .

## 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)"](https://www.ambetterhealth.com/en/tx/provider-resources/manuals-and-forms/grievance-appeals/) , 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)"](https://www.ambetterhealth.com/content/dam/centene/Sunshine/Ambetter/PDFs/AMB-TX-Appeals-Grievances-Guide.pdf) , 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.com

[Get my Appeal Kit, $29](/appeal-kit)
Everything 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.

Where these numbers come from 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](https://data.healthcare.gov/) . Rights and timeframes: [29 CFR 2560.503-1](https://www.ecfr.gov/current/title-29/section-2560.503-1) (180 days, and your free right to the claim file) and [45 CFR 147.136](https://www.ecfr.gov/current/title-45/section-147.136) (4 months, and what qualifies), explained at [HealthCare.gov](https://www.healthcare.gov/appeal-insurance-company-decision/external-review/) . 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)](https://www.govinfo.gov/content/pkg/CFR-2024-title29-vol9/pdf/CFR-2024-title29-vol9-sec2560-503-1.pdf) and [govinfo.gov (45 CFR 147.136)](https://www.govinfo.gov/content/pkg/CFR-2024-title45-vol2/pdf/CFR-2024-title45-vol2-sec147-136.pdf) .

This page presents federal statistics and a general description of appeal rights created by federal law. It is not legal, medical, or insurance advice, and no outcome is guaranteed. Your denial letter and plan documents govern your specific case. Free help is available from your state's Consumer Assistance Program and from the federal Marketplace at HealthCare.gov.

Problem solved: You have both dates for your Celtic Insurance Company notice, you know that an insured plan in Texas goes to the federal process, and you have the letter, free, on this screen, tonight.

## The pages that answer the next question

- [Every insurer reporting in Texas](/states/texas) , the state's own row, the 16 companies filing there, and the Texas insurance department's consumer number, read at source.

- [Centene Venture Company Florida in Florida](/insurers/centene-venture-company-florida--fl) , 9.8% of in-network claims denied, 5,291,270 of them, the neighboring record in this file.

- [CHRISTUS Health Plan in Texas](/insurers/christus-health-plan--tx) , 11.1% of in-network claims denied, 208,818 of them, the neighboring record in this file.

- [CHRISTUS Health Plan Louisiana in Louisiana](/insurers/christus-health-plan-louisiana--la) , 20.1% of in-network claims denied, 35,194 of them, the neighboring record in this file.

- [If your employer pays the claims itself](/self-funded-denial) , then Celtic Insurance Company is only administering the plan, your state's external review has no power over the denial, and the route is federal. It is the first question our own calculator asks. 16 insurers report in Texas; whether your plan is one of theirs at all is what that page settles.

- [If it was refused before the treatment](/prior-authorization-denied) , a prior-authorization refusal from Celtic Insurance Company runs on the same two federal clocks as a denied claim, and it can be appealed while the treatment is still ahead of you. 24,184,622 in-network claims were denied in Texas in this release; a refusal before the treatment is not counted among them and is appealed the same way.

- [Before you pay a lawyer](/before-you-call-a-lawyer) , two free appeals run before anyone bills you by the hour, and Celtic Insurance Company has to hand you the claim file for nothing under 29 CFR 2560.503-1. Free help in Texas starts with the state consumer line printed on that state's page.

- [All 152 insurer-state records](/insurers) , the whole table, ranked, with Celtic Insurance Company in it and the 16 that file in Texas beside it.

Your dates are ready. [Write the letter, free](/appeal-letter)

## The two federal clocks

The clock your letter has to describe, in actual dates Whatever else is on the page, these two dates are the page. 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.

## How rare the second appeal is

You are not alone, measured rather than said: 83,907,852 in-network claims were denied in a single plan year, and only 4,918 of them, one in 17,061, ever reached the independent review stage. Of the ones that did, 22.2% (1,092 of 4,918; interval 22.2-23.8% for counts CMS withheld; 32.6% without SelectHealth) were overturned.

## What is free here, and what the one paid thing costs

Denied a claim? Insurers upheld 165,863 of the 262,982 internal appeals counted in 2024, 63.1% ( KFF ). The win is at independent external review, and the only way to arrive there is to run the internal stage on time, in the right order, with the record intact. That sequence is what the Appeal Kit is. Get my Appeal Kit, $29 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. Get my Appeal Kit, $29 Everything you need for your appeal: 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.

## What we will not pretend

What we will not pretend. We cannot overturn your denial. Only your plan, or an independent reviewer, can do that. We cannot make your plan cover a service it genuinely excludes. We cannot guarantee external review applies to your denial. It covers medical judgment, experimental or investigational determinations, and rescission, a purely administrative denial may not qualify, and we say so on those pages rather than selling you past it. We have no customer testimonials and publish none. Our evidence is the federal dataset and the regulation cites, both of which you can check.

## Every page on this site

Home Start here Insurers By company States Denial reasons Use cases How to appeal Ranked by denial rate The external-review gap Write the letter, free Deadline calculator Self-funded plan? Prior authorization denied Medicare WISeR denial Denial code CO-50 Before you call a lawyer Attorney for a denied claim Your denial letter United Healthcare denying claims Time limits on a claim Appeal a Medicare denial About Editorial policy How we compare Privacy Terms For machines: llms.txt openapi.json changes.json the composed answer this page as markdown

## Which release these figures are

Which release these figures are Every number on this page is the plan-year 2027 Transparency in Coverage file, issued October 22, 2026, covering plan-year 2025 claims. This is the newest plan year CMS has published: there is no Transparency in Coverage file for a plan year after 2027. The dataset list is at data.healthcare.gov . A test in this site’s build fetches that list on every run and fails if CMS publishes a plan year we have not acknowledged here. Every earlier release, plan-year 2024, plan-year 2025, plan-year 2026, is kept alongside it so the record is visible rather than a single year’s snapshot; /about says what changed between them. From the plan-year 2024 release to the plan-year 2026 release, external reviews filed went from 2,336 to 5,881. Overturned reviews went from 32.8% in the plan-year 2026 release to 22.2% in plan-year 2027, or from 32.6% to 32.6% without SelectHealth. We do not compare filed or overturned counts across plan-years 2026 and 2027. Some issuers may have counted pre-service appeals in their 2026 cells.

## Where these numbers come from

Where these numbers come from 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) .

## Who publishes this

Denial Facts publishes federal data about health insurance claim denials. We are independent: not affiliated with, endorsed by, or acting for any insurer, government agency, or review organization. We are not a law firm, a medical provider, or an insurance producer, and nothing here is legal, medical, or insurance advice. Data: CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 claims), data.healthcare.gov — US Government public domain. Figures cover individual-market Qualified Health Plans on the federal Exchange and come from the plan-year 2027 release, issued October 22, 2026, covering plan-year 2025 claims. This is the newest plan year CMS has published: there is no Transparency in Coverage file for a plan year after 2027. See where the data comes from .

## Sources

- CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 claims), data.healthcare.gov — US Government public domain: https://data.healthcare.gov/
- CCIIO state external review table (read August 3, 2026): https://www.cms.gov/CCIIO/Resources/Files/external_appeals
- 29 CFR 2560.503-1 (180 days, and your free right to the claim file): https://www.ecfr.gov/current/title-29/section-2560.503-1
- 45 CFR 147.136 (4 months, and what qualifies): https://www.ecfr.gov/current/title-45/section-147.136
- HealthCare.gov on external review: https://www.healthcare.gov/appeal-insurance-company-decision/external-review/

Cite: Axion Labs — Denial Facts, "Celtic TX appeal form and deadline", https://denialfacts.com/insurers/celtic-insurance-company--tx (checked 2026-11-04). free to quote with the URL.