Health Alliance Medical Plans, Inc. claim denials in Illinois: the federal figures
Health Alliance Medical Plans, Inc. denied 11.7% of in-network claims in Illinois — 167,432 claims out of 1,434,025. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Health Alliance Medical Plans, Inc.) | 227 | 44.9% |
| External review (independent) | 17 | — |
What Health Alliance Medical Plans, Inc. denies most
The most common denial reason recorded for Health Alliance Medical Plans, Inc. plans in Illinois is other reasons. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Other reasons | 31,824 | 72% |
| Administrative reason | 6,220 | 14.1% |
| Member not covered | 3,383 | 7.7% |
| Referral required | 1,807 | 4.1% |
| Service excluded from the plan | 527 | 1.2% |
| Benefit limit reached | 402 | 0.9% |
| Provider out of network | 11 | 0% |
What to do if Health Alliance Medical Plans, Inc. 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. Health Alliance Medical Plans, Inc. overturned 44.9% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Health Alliance Medical Plans, Inc.. 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 Health Alliance Medical Plans, Inc. 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 Health Alliance Medical Plans, Inc.'s denial rate high?
11.7% 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 Health Alliance Medical Plans, Inc. ignore the external decision?
No. External review decisions are binding on the plan.