Oscar Buckeye State Insurance Corp. claim denials in Ohio: the federal figures
Oscar Buckeye State Insurance Corp. denied 13.3% of in-network claims in Ohio — 52,812 claims out of 397,995. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Oscar Buckeye State Insurance Corp.) | 276 | 50.4% |
| External review (independent) | — | — |
What Oscar Buckeye State Insurance Corp. denies most
The most common denial reason recorded for Oscar Buckeye State Insurance Corp. plans in Ohio is administrative reason. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Administrative reason | 13,652 | 30.7% |
| Service excluded from the plan | 13,496 | 30.3% |
| Benefit limit reached | 10,368 | 23.3% |
| Referral required | 2,713 | 6.1% |
| Provider out of network | 1,799 | 4% |
| Not medically necessary | 1,372 | 3.1% |
| Other reasons | 1,064 | 2.4% |
| Member not covered | 11 | 0% |
What to do if Oscar Buckeye State Insurance Corp. 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. Oscar Buckeye State Insurance Corp. overturned 50.4% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Oscar Buckeye State Insurance Corp.. 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 Oscar Buckeye State Insurance Corp. 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 Oscar Buckeye State Insurance Corp.'s denial rate high?
13.3% 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 Oscar Buckeye State Insurance Corp. ignore the external decision?
No. External review decisions are binding on the plan.