Medica denied your claim in Missouri. Here is your deadline.
Put in the date on your Medica Insurance Company notice and get both federal deadlines as calendar dates.
Free, for a Medica Insurance Company denial in Missouri, 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 Insurance Company denied 127,628 of 621,628 in-network claims in Missouri; every one of those denials had these same two dates on it. Across Missouri as a whole the insurers in this file denied 11.7% of in-network claims, 1,592,551 of them, and 3,649 were appealed.
Or let the $29 Appeal Kit date each step and write the claim-file and external-review requests.
Medica Insurance Company denied 20.5% of in-network claims in Missouri, 127,628 claims out of 621,628.
Further down this page, after the free steps: the paid next step.
Insurance got denied, what to do next?
Those 127,628 denials are 8% of every in-network denial recorded in Missouri in this release, which makes Medica Insurance Company the 4th largest source of denials of the 6 insurers reporting there. Spread across its 16 plans in the state that is about 7,977 denials per plan. 94 internal appeals were filed against those 127,628 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 Missouri 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: 127,628 in-network claims were denied by Medica Insurance Company in Missouri 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 6 insurers reporting a denial rate in Missouri, Medica Insurance Company is the second highest at 20.5%. The highest in the state is 24.5% and the lowest is 7.3%.
- That is 4.8 percentage points above the 15.7% national average across this dataset, and 8.8 points above the Missouri average of 11.7%.
- Behind the percentage: 621,628 in-network claims were processed under 16 plans in Missouri, and 127,628 of them came back denied.
- For every 10,000 claims Medica Insurance Company denied, about 7 came back as an internal appeal. The other 9,993 stopped at the letter.
- Of the internal appeals it did receive, Medica Insurance Company overturned 37.23%, 35 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 49.7% 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 Missouri, Medica Insurance Company reported 20.5%, and the same company files in 2 other states in this file, where the rate is not the same in any of them: 23.8% in North Dakota, 18.9% in Nebraska. Which state the plan was bought in moves the odds more than the brand on the card does.
- Medica Insurance Company accounts for 8% of every in-network claim denied in Missouri in this file.
- By raw volume it is the 77th 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, 11,976 claims, 17.2% of its categorized denials.
- Third on its own list is service excluded from the plan, 7,686 claims, 11% of what Medica Insurance Company categorized in Missouri. Between them the top three account for 77.9% of its categorized denials.
- Where Medica Insurance Company differs most from the national mix is administrative reason: 49.7% of its categorized denials in Missouri against 17.2% across the file.
- Read the other way round: 494,000 of those 621,628 in-network claims were paid, 79.5% of everything Medica Insurance Company processed in Missouri.
- Spread across the 16 plans it reports in Missouri, that is about 7,977 denied claims per plan, on about 38,852 claims processed per plan.
- Its reason columns add up to 69,783 categorized rows against 127,628 denials, 54.7% 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 Missouri is provider out of network, 875 claims, 1.3% of what Medica Insurance Company categorized there.
- Against the file as a whole, this one record is 0.2% 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 Insurance Company records most often in Missouri 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 Insurance Company in Missouri 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 Insurance Company overturned 37.23% of the internal appeals it did receive, 35 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 Insurance Company | 20.5% | , |
| Missouri average | 11.7% | +8.8 pts |
| National average (this dataset) | 15.7% | +4.8 pts |
Medica Insurance Company denies 4.8 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 Insurance Company) | 94 | 37.23% |
| External review (independent) | 0 | not reported |
The gap nobody escalated
127,628 claims denied. 94 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 Insurance Company letter, and by when. Medica Insurance Company overturned 37.23% of the 94 internal appeals its Missouri members filed against 127,628 denials, and not one of those Missouri denials went on to the independent stage whose decision binds the plan, Medica Insurance Company'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 Insurance Company 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 Insurance Company in Missouri. One payment. No subscription. No cut of your claim.
Medica Insurance Company inside Missouri
Your denial did not happen in a national average. It happened in a state market, alongside 5 other insurers reporting into the same federal file, and these are that market's own figures.
- Across the whole of Missouri, the 6 insurers reporting in this file processed 13,603,345 in-network claims and denied 1,592,551 of them, a state denial rate of 11.7%. Medica Insurance Company is one of those 6.
- That puts Missouri 24th of 29 states by denial rate, 4 points below the 15.7% national average, before you get to what Medica Insurance Company did inside it.
- Missouri recorded 3,649 internal appeals against those denials: one appeal for every 436 claims the state's insurers refused. Medica Insurance Company's own ratio is one for every 1,358.
- Independent external review was reached 12 times in the whole of Missouri, once for every 132,713 denials, against one in 17,061 nationally. None of them came from Medica Insurance Company's denials.
- Of the Missouri external reviews that were filed, 0 were overturned, 0%. That percentage is measured on 12 reviews, which is why the count beside it matters more than the rate does when you are deciding whether to file against Medica Insurance Company.
- The reason Missouri's insurers record most often is other reasons, 419,419 claims, 18.3% of the state's categorized denials. Medica Insurance Company records administrative reason most often instead, which is the argument your letter will need to answer.
- The other insurers a Missouri reader could have bought from run from 24.5% (Blue Cross and Blue Shield of Kansas City) to 7.3% (Healthy Alliance Life Insurance Company). Medica Insurance Company at 20.5% sits between the two.
- Put the two together and Medica Insurance Company is responsible for 8% of every in-network claim denied in Missouri in this release, from 4.6% of the claims the state's insurers processed.
- Every Missouri figure in this section is that state's own row in the same federal file Medica Insurance Company'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 Missouri page is free at /states/missouri.
What Medica Insurance Company denies most
The most common denial reason recorded for Medica Insurance Company plans in Missouri is administrative reason. How that denial is beaten →
| Denial reason | Claims | Share | National share |
|---|---|---|---|
| Administrative reason | 34,717 | 49.7% | 17.2% |
| Member not covered | 11,976 | 17.2% | 7.9% |
| Service excluded from the plan | 7,686 | 11% | 13.4% |
| Other reasons | 6,784 | 9.7% | 32.4% |
| Referral required | 4,204 | 6% | 9.6% |
| Benefit limit reached | 3,541 | 5.1% | 4.9% |
| Provider out of network | 875 | 1.3% | 9% |
The last column is each reason's share of all categorized denials nationally, so you can see where Medica Insurance Company's mix in Missouri 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.
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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 Insurance Company overturned 37.23% of the internal appeals it received.
Questions
Is Medica Insurance Company's denial rate in Missouri high?
20.5% 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 Insurance Company denial in Missouri, and how many won?
94 internal appeals were filed against 127,628 denials, and 37.23% of them were overturned (35 claims). Not one went on to independent external review, the stage whose decision is binding on the plan.
How does Medica Insurance Company compare with other insurers in Missouri?
Of the 6 insurers in Missouri with a reported denial rate, Medica Insurance Company ranks 2 highest at 20.5%. The highest in Missouri is Blue Cross and Blue Shield of Kansas City at 24.5%; the lowest is Healthy Alliance Life Insurance Company at 7.3%.
What does Medica Insurance Company deny most often in Missouri?
Administrative reason, 34,717 claims, 49.7% 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 Insurance Company denial in Missouri?
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 Missouri, Medica Insurance Company 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 Insurance Company denial in Missouri cost anything?
The internal appeal to Medica Insurance Company 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 Missouri can be charged more than that to file one.
Can Medica Insurance Company ignore an external review decision in Missouri?
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 127,628 Medica Insurance Company denials in Missouri the striking number on this page.
The line on this page we would read twice is the one that says not one of Medica Insurance Company's 127,628 denials in Missouri 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 Insurance Company appeal in Missouri: 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 Insurance Company figures on this page, the 20.5% denial rate, the 127,628 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).