Medica denied your claim in North Dakota. Here is your deadline.
Put in the date on your Medica Health Plans notice and get both federal deadlines as calendar dates.
Free, for a Medica Health Plans denial in North Dakota, and it runs entirely in your browser. The date, the plan type and the state you pick are never sent to us and never stored.
Medica Health Plans denied 31,275 of 131,657 in-network claims in North Dakota; every one of those denials had these same two dates on it. Across North Dakota as a whole the insurers in this file denied 6.8% of in-network claims, 105,786 of them, and 227 were appealed.
Or let the $29 Appeal Kit date each step and write the claim-file and external-review requests.
Medica Health Plans denied 23.8% of in-network claims in North Dakota, 31,275 claims out of 131,657.
Further down this page, after the free steps: the paid next step.
Insurance got denied, what to do next?
Those 31,275 denials are 29.6% of every in-network denial recorded in North Dakota in this release, which makes Medica Health Plans the 2nd largest source of denials of the 3 insurers reporting there. Spread across its 16 plans in the state that is about 1,955 denials per plan. 30 internal appeals were filed against those 31,275 denials. Every one of those denials carried the same two dates the tool at the top of this page works out.
Two dates matter more than anything else on this page, and they run the same in North Dakota as everywhere else. You have 180 days from the date on your denial notice to file the internal appeal, and then 4 months from the final internal denial to ask for an independent external review. If waiting would seriously jeopardize your health you can ask for both to be expedited, decided in about 72 hours. Both timeframes are federal, not your insurer's choice, 29 CFR 2560.503-1 (PDF) and 45 CFR 147.136 (PDF), in plain English at HealthCare.gov, and your own denial letter states the ones that govern your plan. The PDFs are the same sections on govinfo.gov, which serves them without a challenge page, so an automated reader can check these two dates as easily as you can.
You are not alone, and here is the measured version of that sentence: 31,275 in-network claims were denied by Medica Health Plans in North Dakota in a single plan year. A denial rate is a fact about an insurer's book of business. It is not a judgment about you, and it is not the last word on your claim.
- Of the 3 insurers reporting a denial rate in North Dakota, Medica Health Plans is the first highest at 23.8%. The highest in the state is 23.8% and the lowest is 3%.
- That is 8.1 percentage points above the 15.7% national average across this dataset, and 17 points above the North Dakota average of 6.8%.
- Behind the percentage: 131,657 in-network claims were processed under 16 plans in North Dakota, and 31,275 of them came back denied.
- For every 10,000 claims Medica Health Plans denied, about 10 came back as an internal appeal. The other 9,990 stopped at the letter.
- Of the internal appeals it did receive, Medica Health Plans overturned 43.33%, 13 claims that started life as a no.
- Not one of those denials reached independent external review, the stage whose decision the plan is required by law to accept, and where nationally 22.2% (1,092 of 4,918; interval 22.2-23.8% for counts CMS withheld; 32.6% without SelectHealth) are overturned.
- Its most-recorded denial reason is administrative reason at 49.2% of its categorized denials, against 17.2% nationally, a heavier share than the country as a whole. That is the denial mix, not an outcome rate.
- In North Dakota, Medica Health Plans reported 23.8%, and the same company files in 2 other states in this file, where the rate is not the same in any of them: 20.5% in Missouri, 18.9% in Nebraska. Which state the plan was bought in moves the odds more than the brand on the card does.
- Medica Health Plans accounts for 29.6% of every in-network claim denied in North Dakota in this file.
- By raw volume it is the 106th largest source of denials among the 135 insurer-state records in the file that report one.
- After that, its second-most-recorded reason is member not covered, 3,204 claims, 24% of its categorized denials.
- Third on its own list is other reasons, 1,159 claims, 8.7% of what Medica Health Plans categorized in North Dakota. Between them the top three account for 81.9% of its categorized denials.
- Where Medica Health Plans differs most from the national mix is administrative reason: 49.2% of its categorized denials in North Dakota against 17.2% across the file.
- Read the other way round: 100,382 of those 131,657 in-network claims were paid, 76.2% of everything Medica Health Plans processed in North Dakota.
- Spread across the 16 plans it reports in North Dakota, that is about 1,955 denied claims per plan, on about 8,229 claims processed per plan.
- Its reason columns add up to 13,331 categorized rows against 31,275 denials, 42.6% of them, and every reason share on this page is a share of that first figure rather than of the second.
- Its smallest recorded category in North Dakota is provider out of network, 343 claims, 2.6% of what Medica Health Plans categorized there.
- Against the file as a whole, this one record is 0% of the 83,907,852 in-network claim denials reported by every issuer in it.
- Find the reason code on your denial letter. The reason Medica Health Plans records most often in North Dakota is administrative reason, but yours may be one of the other 8, copy the exact wording and code off your own letter tonight, because that sentence is what your appeal has to answer.
- Ask Medica Health Plans in North Dakota for the clinical criteria they judged you against. Under 29 CFR 2560.503-1 they have to hand you the claim file and the policy they applied, free, on request, and you cannot argue with a checklist you have never read.
- Put both deadlines on your calendar before you go to bed. 180 days from the date on the letter for the internal appeal, 4 months from the final internal denial for external review. The free calculator on this page turns your date into the two calendar dates in about ten seconds. Medica Health Plans overturned 43.33% of the internal appeals it did receive, 13 claims, so the stage you are about to start is not decorative.
None of those three steps costs anything. Anyone charging you to do them is selling you something you can do yourself in twenty minutes.
How that compares
| Denial rate | Rate | Difference |
|---|---|---|
| Medica Health Plans | 23.8% | , |
| North Dakota average | 6.8% | +17 pts |
| National average (this dataset) | 15.7% | +8.1 pts |
Medica Health Plans denies 8.1 percentage points more of its in-network claims than the national average across this dataset. A denial rate is a property of the insurer's book of business, coding practice, plan design, the population it covers, not evidence about the merits of any one claim, including yours.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Medica Health Plans) | 30 | 43.33% |
| External review (independent) | 0 | not reported |
The gap nobody escalated
31,275 claims denied. 30 internal appeals filed. None reached independent external review. Nationally 22.2% (1,092 of 4,918; interval 22.2-23.8% for counts CMS withheld; 32.6% without SelectHealth) of external reviews are overturned and the decision binds the plan.
That is arithmetic from the reported figures, not a prediction: nobody can say what those specific denials would have done at review, because they never got there. What the numbers do establish is that the binding stage was almost entirely unused here.
What that record means for your own Medica Health Plans letter, and by when. Medica Health Plans overturned 43.33% of the 30 internal appeals its North Dakota members filed against 31,275 denials, and not one of those North Dakota denials went on to the independent stage whose decision binds the plan, Medica Health Plans's own rows in the plan-year 2027 release of the CMS Transparency in Coverage file, read November 4, 2026 (data.healthcare.gov). Whichever way that lands, nobody files the appeal for you, and the filing runs on a clock set by which plan you hold: an employer or Marketplace plan gives you at least 180 days from the denial notice to file the internal appeal (29 CFR 2560.503-1(h)(3)(i), carried onto individual-market coverage by 45 CFR 147.136(b)(3)(i)), while Medicare Advantage gives you 65 calendar days from the date of its notice (CMS, 42 CFR 422.582(b)) and Medicaid managed care 60 calendar days from the date on the notice (42 CFR 438.402(c)(2)(ii)), both stages free, and the three steps above are the whole of what to do tonight, so take the date printed on your Medica Health Plans notice and file well inside whichever of those windows is yours. The free steps are above; the $29 kit is the same clock with the letters pre-filled for Medica Health Plans in North Dakota. One payment. No subscription. No cut of your claim.
Medica Health Plans inside North Dakota
Your denial did not happen in a national average. It happened in a state market, alongside 2 other insurers reporting into the same federal file, and these are that market's own figures.
- Across the whole of North Dakota, the 3 insurers reporting in this file processed 1,557,969 in-network claims and denied 105,786 of them, a state denial rate of 6.8%. Medica Health Plans is one of those 3.
- That puts North Dakota 28th of 29 states by denial rate, 8.9 points below the 15.7% national average, before you get to what Medica Health Plans did inside it.
- North Dakota recorded 227 internal appeals against those denials: one appeal for every 466 claims the state's insurers refused. Medica Health Plans's own ratio is one for every 1,043.
- Not one denial in North Dakota reached independent external review in the reported year, not Medica Health Plans's and not any other insurer's in the state. That is the stage whose decision the plan is required by law to accept.
- The reason North Dakota's insurers record most often is other reasons, 61,258 claims, 69.9% of the state's categorized denials. Medica Health Plans records administrative reason most often instead, which is the argument your letter will need to answer.
- The other insurers a North Dakota reader could have bought from run from 7.1% (Blue Cross Blue Shield of North Dakota) to 3% (Sanford Health Plan). Medica Health Plans at 23.8% sits above all of them.
- Put the two together and Medica Health Plans is responsible for 29.6% of every in-network claim denied in North Dakota in this release, from 8.5% of the claims the state's insurers processed.
- Every North Dakota figure in this section is that state's own row in the same federal file Medica Health Plans's numbers above come from, CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 claims), data.healthcare.gov — US Government public domain, and the full North Dakota page is free at /states/north-dakota.
What Medica Health Plans denies most
The most common denial reason recorded for Medica Health Plans plans in North Dakota is administrative reason. How that denial is beaten →
| Denial reason | Claims | Share | National share |
|---|---|---|---|
| Administrative reason | 6,558 | 49.2% | 17.2% |
| Member not covered | 3,204 | 24% | 7.9% |
| Other reasons | 1,159 | 8.7% | 32.4% |
| Service excluded from the plan | 795 | 6% | 13.4% |
| Referral required | 724 | 5.4% | 9.6% |
| Benefit limit reached | 548 | 4.1% | 4.9% |
| Provider out of network | 343 | 2.6% | 9% |
The last column is each reason's share of all categorized denials nationally, so you can see where Medica Health Plans's mix in North Dakota differs from everyone else's. This is denial mix, not overturn rate by reason, the federal file does not report appeal outcomes broken down by denial reason, and we do not imply otherwise.
Put the date from your notice in and get the two calendar dates, with the days remaining.
Runs entirely in your browser, the date you type is never sent to us and never stored. Open the full calculator →
Or let the $29 Appeal Kit date each step and write the claim-file and external-review requests.
The three steps at the top of this page are the whole of what you have to do tonight. The longer version, what the internal appeal has to contain, how the independent stage works, and how to ask for expedited handling when waiting would seriously jeopardize your health, is published free here. For what it is worth on this page specifically: Medica Health Plans overturned 43.33% of the internal appeals it received.
Questions
Is Medica Health Plans's denial rate in North Dakota high?
23.8% against a national average of 15.7% across the plans in this dataset. It is above average. A denial rate describes the insurer, not the merits of your claim.
How many people appealed a Medica Health Plans denial in North Dakota, and how many won?
30 internal appeals were filed against 31,275 denials, and 43.33% of them were overturned (13 claims). Not one went on to independent external review, the stage whose decision is binding on the plan.
How does Medica Health Plans compare with other insurers in North Dakota?
Of the 3 insurers in North Dakota with a reported denial rate, Medica Health Plans ranks 1 highest at 23.8%. The highest in North Dakota is Medica Health Plans at 23.8%; the lowest is Sanford Health Plan at 3%.
What does Medica Health Plans deny most often in North Dakota?
Administrative reason, 6,558 claims, 49.2% of this issuer's categorized denials, against 17.2% nationally. This is the denial-reason mix; the federal file does not report overturn rates by reason.
How long do I have to appeal a Medica Health Plans denial in North Dakota?
Generally 180 days from the date on the denial notice to file the internal appeal, then generally four months from the final internal denial to request independent external review. Expedited review, decided in about 72 hours, is available where delay would seriously jeopardize your health. Those timeframes are federal, so they are identical for every insurer reporting in North Dakota, Medica Health Plans included, what varies by state is who runs the independent review at the end. Your own denial letter states the deadlines that govern your plan; that letter is the authority.
Does appealing a Medica Health Plans denial in North Dakota cost anything?
The internal appeal to Medica Health Plans 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 per review. Nobody in North Dakota can be charged more than that to file one.
Can Medica Health Plans ignore an external review decision in North Dakota?
No, and that is the whole point of the stage. External review decisions are binding on the plan by law, which is what makes the zero external reviews recorded against 31,275 Medica Health Plans denials in North Dakota the striking number on this page.
The line on this page we would read twice is the one that says not one of Medica Health Plans's 31,275 denials in North Dakota reached independent review. We are not going to tell you that you will win. This page prints the insurer's own reported numbers whichever way they fall. If what it says does not match the letter in your hand, write to us and we will correct the page.
Axion Labs · hello@getaxionlabs.comEverything you need for your Medica Health Plans appeal in North Dakota: your two deadlines, the argument that fits your denial reason, the letters, a brief for your doctor on what the reviewer checks, and the external review request. One payment. No subscription. No cut of your claim. Opens on screen the moment you pay. 14-day refund, no questions, one email to hello@getaxionlabs.com.
The Medica Health Plans figures on this page, the 23.8% denial rate, the 31,275 denials and the 0 external reviews, are this issuer’s own reported rows in that file.
Counts: CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 claims), data.healthcare.gov — US Government public domain. Rights and timeframes: 29 CFR 2560.503-1 (180 days, and your free right to the claim file) and 45 CFR 147.136 (4 months, and what qualifies), explained at HealthCare.gov. Expedited review is decided in about 72 hours under both sections.
Reading either regulation from a script rather than a browser: eCFR answers automated fetches with a challenge page, so the same two sections are mirrored as government PDFs at govinfo.gov (29 CFR 2560.503-1) and govinfo.gov (45 CFR 147.136).