MercyCare HMO denied your claim in Wisconsin. Here is your deadline.
Put in the date on your MercyCare HMO, Inc. notice and get both federal deadlines as calendar dates.
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MercyCare HMO, Inc. denied 20,778 of 189,559 in-network claims in Wisconsin; every one of those denials had these same two dates on it. Across Wisconsin as a whole the insurers in this file denied 15.4% of in-network claims, 1,893,070 of them, and 2,216 were appealed.
Or let the $29 Appeal Kit date each step and write the claim-file and external-review requests.
MercyCare HMO, Inc. denied 11% of in-network claims in Wisconsin, 20,778 claims out of 189,559.
Further down this page, after the free steps: the paid next step.
Insurance got denied, what to do next?
Those 20,778 denials are 1.1% of every in-network denial recorded in Wisconsin in this release, which makes MercyCare HMO, Inc. the 11th largest source of denials of the 12 insurers reporting there. Spread across its 6 plans in the state that is about 3,463 denials per plan. 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 Wisconsin 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: 20,778 in-network claims were denied by MercyCare HMO, Inc. in Wisconsin 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 12 insurers reporting a denial rate in Wisconsin, MercyCare HMO, Inc. is the eighth highest at 11%. The highest in the state is 24.5% and the lowest is 6.5%.
- That is 4.7 percentage points below the 15.7% national average across this dataset, and 4.4 points below the Wisconsin average of 15.4%.
- Behind the percentage: 189,559 in-network claims were processed under 6 plans in Wisconsin, and 20,778 of them came back denied.
- 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 other reasons at 63.2% of its categorized denials, against 32.4% nationally, a heavier share than the country as a whole. That is the denial mix, not an outcome rate.
- MercyCare HMO, Inc. accounts for 1.1% of every in-network claim denied in Wisconsin in this file.
- By raw volume it is the 113th 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, 4,740 claims, 12.9% of its categorized denials.
- Third on its own list is service excluded from the plan, 4,071 claims, 11.1% of what MercyCare HMO, Inc. categorized in Wisconsin. Between them the top three account for 87.2% of its categorized denials.
- Where MercyCare HMO, Inc. differs most from the national mix is other reasons: 63.2% of its categorized denials in Wisconsin against 32.4% across the file.
- Read the other way round: 168,781 of those 189,559 in-network claims were paid, 89% of everything MercyCare HMO, Inc. processed in Wisconsin.
- Spread across the 6 plans it reports in Wisconsin, that is about 3,463 denied claims per plan, on about 31,593 claims processed per plan.
- Its reason columns add up to 36,726 categorized rows against 20,778 denials, 176.8% 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 Wisconsin is provider out of network, 352 claims, 1% of what MercyCare HMO, Inc. 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 MercyCare HMO, Inc. records most often in Wisconsin is other reasons, 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 MercyCare HMO, Inc. in Wisconsin 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. 20,778 claims were denied here in a single year and not one was escalated; the deadline is what decides whether anyone reads the argument.
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 |
|---|---|---|
| MercyCare HMO, Inc. | 11% | , |
| Wisconsin average | 15.4% | -4.4 pts |
| National average (this dataset) | 15.7% | -4.7 pts |
MercyCare HMO, Inc. sits at or below 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 MercyCare HMO, Inc.) | not reported | not reported |
| External review (independent) | 0 | not reported |
The gap nobody escalated
20,778 claims denied. not reported 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 MercyCare HMO, Inc. letter, and by when. MercyCare HMO, Inc. recorded 20,778 denials in Wisconsin and no separately reported appeal outcome, so this page cannot tell you how its Wisconsin appeals went, the MercyCare HMO, Inc. 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 MercyCare HMO, Inc. 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 MercyCare HMO, Inc. in Wisconsin. One payment. No subscription. No cut of your claim.
MercyCare HMO, Inc. inside Wisconsin
Your denial did not happen in a national average. It happened in a state market, alongside 11 other insurers reporting into the same federal file, and these are that market's own figures.
- Across the whole of Wisconsin, the 12 insurers reporting in this file processed 12,326,174 in-network claims and denied 1,893,070 of them, a state denial rate of 15.4%. MercyCare HMO, Inc. is one of those 12.
- That puts Wisconsin 18th of 29 states by denial rate, 0.3 points below the 15.7% national average, before you get to what MercyCare HMO, Inc. did inside it.
- Wisconsin recorded 2,216 internal appeals against those denials: one appeal for every 854 claims the state's insurers refused.
- Independent external review was reached 12 times in the whole of Wisconsin, once for every 157,756 denials, against one in 17,061 nationally. None of them came from MercyCare HMO, Inc.'s denials.
- Of the Wisconsin 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 MercyCare HMO, Inc..
- The reason Wisconsin's insurers record most often is other reasons, 687,434 claims, 34.3% of the state's categorized denials. MercyCare HMO, Inc. records the same one most often, so your letter is likely to say it too.
- The other insurers a Wisconsin reader could have bought from run from 24.5% (Common Ground Healthcare Cooperative) to 6.5% (HealthPartners Insurance Company). MercyCare HMO, Inc. at 11% sits between the two.
- Put the two together and MercyCare HMO, Inc. is responsible for 1.1% of every in-network claim denied in Wisconsin in this release, from 1.5% of the claims the state's insurers processed.
- Every Wisconsin figure in this section is that state's own row in the same federal file MercyCare HMO, Inc.'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 Wisconsin page is free at /states/wisconsin.
What MercyCare HMO, Inc. denies most
The most common denial reason recorded for MercyCare HMO, Inc. plans in Wisconsin is other reasons. How that denial is beaten →
| Denial reason | Claims | Share | National share |
|---|---|---|---|
| Other reasons | 23,229 | 63.2% | 32.4% |
| Member not covered | 4,740 | 12.9% | 7.9% |
| Service excluded from the plan | 4,071 | 11.1% | 13.4% |
| Administrative reason | 2,246 | 6.1% | 17.2% |
| Referral required | 2,088 | 5.7% | 9.6% |
| Provider out of network | 352 | 1% | 9% |
The last column is each reason's share of all categorized denials nationally, so you can see where MercyCare HMO, Inc.'s mix in Wisconsin 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.
Questions
Is MercyCare HMO, Inc.'s denial rate in Wisconsin high?
11% against a national average of 15.7% across the plans in this dataset. It is at or below average. A denial rate describes the insurer, not the merits of your claim.
How many people appealed a MercyCare HMO, Inc. denial in Wisconsin, and how many won?
Appeal volumes were not separately reported for MercyCare HMO, Inc. in Wisconsin. Across Wisconsin as a whole 2,216 internal appeals were filed against 1,893,070 denials, one for every 854 refused, and that is the state figure, not this company's. Nationally, 26.8% of internal appeals and 22.2% of external reviews are overturned.
How does MercyCare HMO, Inc. compare with other insurers in Wisconsin?
Of the 12 insurers in Wisconsin with a reported denial rate, MercyCare HMO, Inc. ranks 8 highest at 11%. The highest in Wisconsin is Common Ground Healthcare Cooperative at 24.5%; the lowest is HealthPartners Insurance Company at 6.5%.
What does MercyCare HMO, Inc. deny most often in Wisconsin?
Other reasons, 23,229 claims, 63.2% of this issuer's categorized denials, against 32.4% 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 MercyCare HMO, Inc. denial in Wisconsin?
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 Wisconsin, MercyCare HMO, Inc. 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 MercyCare HMO, Inc. denial in Wisconsin cost anything?
The internal appeal to MercyCare HMO, Inc. 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 Wisconsin can be charged more than that to file one.
Can MercyCare HMO, Inc. ignore an external review decision in Wisconsin?
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 20,778 MercyCare HMO, Inc. denials in Wisconsin the striking number on this page.
The line on this page we would read twice is the one that says not one of MercyCare HMO, Inc.'s 20,778 denials in Wisconsin 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 MercyCare HMO, Inc. appeal in Wisconsin: 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 MercyCare HMO, Inc. figures on this page, the 11% denial rate, the 20,778 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).