Kaiser Foundation Healthplan of the NW claim denials in Oregon: the federal figures
Kaiser Foundation Healthplan of the NW denied 7.3% of in-network claims in Oregon — 1,164 claims out of 15,922. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Kaiser Foundation Healthplan of the NW) | 76 | 51.3% |
| External review (independent) | — | — |
What Kaiser Foundation Healthplan of the NW denies most
The most common denial reason recorded for Kaiser Foundation Healthplan of the NW plans in Oregon is referral required. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Referral required | 679 | 39.3% |
| Other reasons | 537 | 31.1% |
| Administrative reason | 510 | 29.5% |
What to do if Kaiser Foundation Healthplan of the NW 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. Kaiser Foundation Healthplan of the NW overturned 51.3% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Kaiser Foundation Healthplan of the NW. 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 Kaiser Foundation Healthplan of the NW 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 Kaiser Foundation Healthplan of the NW's denial rate high?
7.3% 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 Kaiser Foundation Healthplan of the NW ignore the external decision?
No. External review decisions are binding on the plan.