Health Net of Arizona, Inc. claim denials in Arizona: the federal figures
Health Net of Arizona, Inc. denied 13.2% of in-network claims in Arizona — 270,924 claims out of 2,058,336. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Health Net of Arizona, Inc.) | 310 | 44.8% |
| External review (independent) | — | — |
What Health Net of Arizona, Inc. denies most
The most common denial reason recorded for Health Net of Arizona, Inc. plans in Arizona is service excluded from the plan. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Service excluded from the plan | 117,925 | 21% |
| Administrative reason | 102,548 | 18.3% |
| Other reasons | 89,210 | 15.9% |
| Benefit limit reached | 80,750 | 14.4% |
| Referral required | 63,596 | 11.3% |
| Not medically necessary | 55,901 | 10% |
| Provider out of network | 34,539 | 6.1% |
| Member not covered | 17,147 | 3.1% |
What to do if Health Net of Arizona, 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 Net of Arizona, Inc. overturned 44.8% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Health Net of Arizona, 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 Net of Arizona, 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 Net of Arizona, Inc.'s denial rate high?
13.2% 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 Net of Arizona, Inc. ignore the external decision?
No. External review decisions are binding on the plan.