Montana Health Cooperative claim denials in Montana: the federal figures
Montana Health Cooperative denied 2.2% of in-network claims in Montana — 2,005 claims out of 90,720. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Montana Health Cooperative) | 30 | — |
| External review (independent) | — | — |
What Montana Health Cooperative denies most
The most common denial reason recorded for Montana Health Cooperative plans in Montana is not medically necessary. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Not medically necessary | 1,192 | 39% |
| Service excluded from the plan | 723 | 23.7% |
| Benefit limit reached | 723 | 23.7% |
| Referral required | 415 | 13.6% |
What to do if Montana Health Cooperative 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.
- If they say no again, go external. An independent organization reviews it — not Montana Health Cooperative. 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 Montana Health Cooperative 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 Montana Health Cooperative's denial rate high?
2.2% 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 Montana Health Cooperative ignore the external decision?
No. External review decisions are binding on the plan.