Dean Health Plan claim denials in Wisconsin: the federal figures
Dean Health Plan denied 11.6% of in-network claims in Wisconsin — 127,692 claims out of 1,099,434. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Dean Health Plan) | 215 | 51.6% |
| External review (independent) | — | — |
What Dean Health Plan denies most
The most common denial reason recorded for Dean Health Plan plans in Wisconsin is other reasons. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Other reasons | 51,245 | 43.6% |
| Administrative reason | 38,076 | 32.4% |
| Service excluded from the plan | 11,917 | 10.1% |
| Referral required | 9,112 | 7.8% |
| Benefit limit reached | 3,316 | 2.8% |
| Member not covered | 2,132 | 1.8% |
| Provider out of network | 1,097 | 0.9% |
| Not medically necessary | 428 | 0.4% |
| Experimental or investigational | 88 | 0.1% |
What to do if Dean 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. Dean Health Plan overturned 51.6% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Dean 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 Dean 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 Dean Health Plan's denial rate high?
11.6% 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 Dean Health Plan ignore the external decision?
No. External review decisions are binding on the plan.