Highmark BCBSD Inc. claim denials in Delaware: the federal figures
Highmark BCBSD Inc. denied 13.2% of in-network claims in Delaware — 127,999 claims out of 968,454. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Highmark BCBSD Inc.) | 141 | 20.6% |
| External review (independent) | — | — |
What Highmark BCBSD Inc. denies most
The most common denial reason recorded for Highmark BCBSD Inc. plans in Delaware is other reasons. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Other reasons | 69,750 | 73.3% |
| Service excluded from the plan | 8,956 | 9.4% |
| Referral required | 6,611 | 7% |
| Member not covered | 6,334 | 6.7% |
| Not medically necessary | 2,995 | 3.1% |
| Provider out of network | 299 | 0.3% |
| Benefit limit reached | 152 | 0.2% |
What to do if Highmark BCBSD 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. Highmark BCBSD Inc. overturned 20.6% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Highmark BCBSD 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 Highmark BCBSD 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 Highmark BCBSD 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 Highmark BCBSD Inc. ignore the external decision?
No. External review decisions are binding on the plan.