Moda denied your claim in Oregon. Here is your deadline.
Put in the date on your Moda Health Plan, Inc. notice and get both federal deadlines as calendar dates.
Free, for a Moda Health Plan, Inc. denial in Oregon, 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.
Moda Health Plan, Inc. denied 157,741 of 1,102,738 in-network claims in Oregon; every one of those denials had these same two dates on it. Across Oregon as a whole the insurers in this file denied 10.9% of in-network claims, 277,498 of them, and 1,265 were appealed.
Moda Health Plan, Inc. denied 14.3% of in-network claims in Oregon, 157,741 claims out of 1,102,738.
Insurance got denied, what to do next?
Those 157,741 denials are 56.8% of every in-network denial recorded in Oregon in this release, which makes Moda Health Plan, Inc. the 1st largest source of denials of the 6 insurers reporting there. Spread across its 13 plans in the state that is about 12,134 denials per plan. 173 internal appeals were filed against those 157,741 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 Oregon 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: 157,741 in-network claims were denied by Moda Health Plan, Inc. in Oregon 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 Oregon, Moda Health Plan, Inc. is the second highest at 14.3%. The highest in the state is 17.4% and the lowest is 4%.
- That is 4.4 percentage points below the 18.7% national average across this dataset, and 3.4 points above the Oregon average of 10.9%.
- Behind the percentage: 1,102,738 in-network claims were processed under 13 plans in Oregon, and 157,741 of them came back denied.
- For every 10,000 claims Moda Health Plan, Inc. denied, about 11 came back as an internal appeal. The other 9,989 stopped at the letter.
- Of the internal appeals it did receive, Moda Health Plan, Inc. overturned 38.73%, 67 claims that started life as a no.
- In Oregon, Moda Health Plan, Inc. reported 14.3%, and the same company files in 2 other states in this file, where the rate is not the same in any of them: 24.3% in Texas, 17.3% in Alaska. Which state the plan was bought in moves the odds more than the brand on the card does.
- Moda Health Plan, Inc. accounts for 56.8% of every in-network claim denied in Oregon in this file.
- By raw volume it is the 79th largest source of denials among the 158 insurer-state records in the file that report one.
- Read the other way round: 944,997 of those 1,102,738 in-network claims were paid, 85.7% of everything Moda Health Plan, Inc. processed in Oregon.
- Spread across the 13 plans it reports in Oregon, that is about 12,134 denied claims per plan, on about 84,826 claims processed per plan.
- Against the file as a whole, this one record is 0.2% of the 84,502,749 in-network claim denials reported by every issuer in it.
- Find the reason code on your denial letter. The federal file records no denial-reason breakdown for Moda Health Plan, Inc. in Oregon, so this page cannot tell you which of the 9 categories yours will be, your letter can, and it has to. Copy the exact wording and the code off it tonight: that sentence is what your appeal has to answer.
- Ask Moda Health Plan, Inc. in Oregon 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. Moda Health Plan, Inc. overturned 38.73% of the internal appeals it did receive, 67 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 |
|---|---|---|
| Moda Health Plan, Inc. | 14.3% | , |
| Oregon average | 10.9% | +3.4 pts |
| National average (this dataset) | 18.7% | -4.4 pts |
Moda Health Plan, 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 Moda Health Plan, Inc.) | 173 | 38.73% |
| External review (independent) | not reported | not reported |
What that record means for your own Moda Health Plan, Inc. letter, and by when. Moda Health Plan, Inc. overturned 38.73% of the 173 internal appeals its Oregon members filed against 157,741 denials, and the Oregon escalation count for Moda Health Plan, Inc. is the figure this page names as absent at the top, so how many of those denials went on to the independent stage is not something this page can tell you, Moda Health Plan, Inc.'s own rows in the plan-year 2026 release of the CMS Transparency in Coverage file, read September 5, 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 60 calendar days after you receive its notice (42 CFR 422.582(b)) and Medicaid managed care the same 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 Moda Health Plan, 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 Moda Health Plan, Inc. in Oregon. One payment. No subscription. No cut of your claim.
Moda Health Plan, Inc. inside Oregon
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 Oregon, the 6 insurers reporting in this file processed 2,552,164 in-network claims and denied 277,498 of them, a state denial rate of 10.9%. Moda Health Plan, Inc. is one of those 6.
- That puts Oregon 27th of 30 states by denial rate, 7.8 points below the 18.7% national average, before you get to what Moda Health Plan, Inc. did inside it.
- Oregon recorded 1,265 internal appeals against those denials: one appeal for every 219 claims the state's insurers refused. Moda Health Plan, Inc.'s own ratio is one for every 912.
- Independent external review was reached 47 times in the whole of Oregon, once for every 5,904 denials, against one in 14,369 nationally. How many came from Moda Health Plan, Inc.'s denials is not on the record, that is the Oregon figure this page names as absent at the top and sources at the foot.
- Of the Oregon external reviews that were filed, 0 were overturned, 0%. That percentage is measured on 47 reviews, which is why the count beside it matters more than the rate does when you are deciding whether to file against Moda Health Plan, Inc..
- The reason Oregon's insurers record most often is other reasons, 139,261 claims, 84% of the state's categorized denials.
- The other insurers an Oregon reader could have bought from run from 17.4% (PacificSource Health Plans) to 4% (Providence Health Plan). Moda Health Plan, Inc. at 14.3% sits between the two.
- Put the two together and Moda Health Plan, Inc. is responsible for 56.8% of every in-network claim denied in Oregon in this release, from 43.2% of the claims the state's insurers processed.
- Every Oregon figure in this section is that state's own row in the same federal file Moda Health Plan, Inc.'s numbers above come from, CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 claims), data.healthcare.gov — US Government public domain, and the full Oregon page is free at /states/oregon.
Put the date from your notice in and get the two calendar dates, with the days remaining.
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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: Moda Health Plan, Inc. overturned 38.73% of the internal appeals it received.
Questions
Is Moda Health Plan, Inc.'s denial rate in Oregon high?
14.3% against a national average of 18.7% 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 Moda Health Plan, Inc. denial in Oregon, and how many won?
173 internal appeals were filed against 157,741 denials, and 38.73% of them were overturned (67 claims). How many went on to independent external review is not on the record for Moda Health Plan, Inc. in Oregon, that is the absence stated at the top of this page and sourced at the foot of it.
How does Moda Health Plan, Inc. compare with other insurers in Oregon?
Of the 6 insurers in Oregon with a reported denial rate, Moda Health Plan, Inc. ranks 2 highest at 14.3%. The highest in Oregon is PacificSource Health Plans at 17.4%; the lowest is Providence Health Plan at 4%.
What does Moda Health Plan, Inc. deny most often in Oregon?
No denial-reason breakdown was reported for Moda Health Plan, Inc. in Oregon. The reason Oregon's insurers recorded most often is other reasons, 139,261 claims, and that is the state's mix, not this company's.
How long do I have to appeal a Moda Health Plan, Inc. denial in Oregon?
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 Oregon, Moda Health Plan, 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 Moda Health Plan, Inc. denial in Oregon cost anything?
The internal appeal to Moda Health Plan, 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 Oregon can be charged more than that to file one.
Can Moda Health Plan, Inc. ignore an external review decision in Oregon?
No, and that is the whole point of the stage. External review decisions are binding on the plan by law. The count is the one this page names as absent for Moda Health Plan, Inc. in Oregon, so none is printed for it, an absent figure is not a count of none.
Moda Health Plan, Inc. sits at 14.3% in Oregon against 18.7% nationally, and that is the whole of what this page can honestly tell you about your own claim. I am 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 me and I will correct the page.
, Andrew at Axion Labs · hello@getaxionlabs.comEverything you need for your Moda Health Plan, Inc. appeal in Oregon: your two deadlines, the argument that fits your denial reason, the letters, the clinician brief, 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 Moda Health Plan, Inc. figures on this page, the 14.3% denial rate, the 157,741 denials, are this issuer’s own reported rows in that file. CMS did not report an external-review figure for Moda Health Plan, Inc. in Oregon in the plan-year 2026 release of the Transparency in Coverage file, which is why no external-review count appears above.
Counts: CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 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).