Nebraska Total Care, Inc. claim denials in Nebraska: the federal figures
Nebraska Total Care, Inc. denied 13.8% of in-network claims in Nebraska — 71,525 claims out of 517,970. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Nebraska Total Care, Inc.) | 204 | 57.4% |
| External review (independent) | — | — |
What Nebraska Total Care, Inc. denies most
The most common denial reason recorded for Nebraska Total Care, Inc. plans in Nebraska is administrative reason. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Administrative reason | 18,882 | 22.6% |
| Service excluded from the plan | 15,849 | 19% |
| Referral required | 11,902 | 14.3% |
| Not medically necessary | 9,947 | 11.9% |
| Benefit limit reached | 9,324 | 11.2% |
| Other reasons | 9,229 | 11.1% |
| Provider out of network | 6,030 | 7.2% |
| Member not covered | 2,310 | 2.8% |
What to do if Nebraska Total Care, Inc. 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. Nebraska Total Care, Inc. overturned 57.4% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Nebraska Total Care, Inc.. 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 Nebraska Total Care, Inc. 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 Nebraska Total Care, Inc.'s denial rate high?
13.8% 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 Nebraska Total Care, Inc. ignore the external decision?
No. External review decisions are binding on the plan.