Oscar denied your claim in Arizona. Here is your deadline.
Put in the date on your Oscar Health Plan, Inc. notice and get both federal deadlines as calendar dates.
Free, for an Oscar Health Plan, Inc. denial in Arizona, 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.
Oscar Health Plan, Inc. denied 69,003 of 387,568 in-network claims in Arizona; every one of those denials had these same two dates on it. Across Arizona as a whole the insurers in this file denied 16.1% of in-network claims, 1,449,189 of them, and 11,145 were appealed.
Or let the $29 Appeal Kit date each step and write the claim-file and external-review requests.
Oscar Health Plan, Inc. denied 17.8% of in-network claims in Arizona, 69,003 claims out of 387,568.
Further down this page, after the free steps: the paid next step.
Insurance got denied, what to do next?
Those 69,003 denials are 4.8% of every in-network denial recorded in Arizona in this release, which makes Oscar Health Plan, Inc. the 4th largest source of denials of the 6 insurers reporting there. Spread across its 22 plans in the state that is about 3,137 denials per plan. 3,448 internal appeals were filed against those 69,003 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 Arizona 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: 69,003 in-network claims were denied by Oscar Health Plan, Inc. in Arizona 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 Arizona, Oscar Health Plan, Inc. is the third highest at 17.8%. The highest in the state is 50.1% and the lowest is 9.5%.
- That is 2.1 percentage points above the 15.7% national average across this dataset, and 1.7 points above the Arizona average of 16.1%.
- Behind the percentage: 387,568 in-network claims were processed under 22 plans in Arizona, and 69,003 of them came back denied.
- For every 10,000 claims Oscar Health Plan, Inc. denied, about 500 came back as an internal appeal. The other 9,500 stopped at the letter.
- Of the internal appeals it did receive, Oscar Health Plan, Inc. overturned 19.72%, 680 claims that started life as a no.
- 15 of those denials went on to independent external review, the stage whose decision the plan is required by law to accept. 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.
- Its most-recorded denial reason is administrative reason at 27.1% of its categorized denials, against 17.2% nationally, a heavier share than the country as a whole. That is the denial mix, not an outcome rate.
- In Arizona, Oscar Health Plan, Inc. reported 17.8%, and the same company files in 8 other states in this file, where the rate is not the same in any of them: 18.7% in Tennessee, 18.4% in Missouri, 18.2% in Michigan, down to 15.3% in Texas. Which state the plan was bought in moves the odds more than the brand on the card does.
- Oscar Health Plan, Inc. accounts for 4.8% of every in-network claim denied in Arizona in this file.
- By raw volume it is the 91th largest source of denials among the 135 insurer-state records in the file that report one.
- Put another way: one independent external review was filed for every 4,600 claims Oscar Health Plan, Inc. denied in Arizona.
- After that, its second-most-recorded reason is other reasons, 29,499 claims, 24.5% of its categorized denials.
- Third on its own list is benefit limit reached, 17,590 claims, 14.6% of what Oscar Health Plan, Inc. categorized in Arizona. Between them the top three account for 66.3% of its categorized denials.
- Where Oscar Health Plan, Inc. differs most from the national mix is administrative reason: 27.1% of its categorized denials in Arizona against 17.2% across the file.
- Read the other way round: 318,565 of those 387,568 in-network claims were paid, 82.2% of everything Oscar Health Plan, Inc. processed in Arizona.
- Spread across the 22 plans it reports in Arizona, that is about 3,137 denied claims per plan, on about 17,617 claims processed per plan.
- Its reason columns add up to 120,313 categorized rows against 69,003 denials, 174.4% 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 Arizona is not medically necessary, 53 claims, 0% of what Oscar Health Plan, Inc. categorized there.
- Against the file as a whole, this one record is 0.1% 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 Oscar Health Plan, Inc. records most often in Arizona is administrative reason, 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 Oscar Health Plan, Inc. in Arizona 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. Oscar Health Plan, Inc. overturned 19.72% of the internal appeals it did receive, 680 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 |
|---|---|---|
| Oscar Health Plan, Inc. | 17.8% | , |
| Arizona average | 16.1% | +1.7 pts |
| National average (this dataset) | 15.7% | +2.1 pts |
Oscar Health Plan, Inc. denies 2.1 percentage points more of its in-network claims than 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 Oscar Health Plan, Inc.) | 3,448 | 19.72% |
| External review (independent) | 15 | not reported |
The gap nobody escalated
69,003 claims denied. 3,448 internal appeals filed. 15 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 Oscar Health Plan, Inc. letter, and by when. Oscar Health Plan, Inc. overturned 19.72% of the 3,448 internal appeals its Arizona members filed against 69,003 denials, and 15 of those Arizona denials went on to the independent stage whose decision binds the plan, Oscar Health Plan, Inc.'s own 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 Oscar 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 Oscar Health Plan, Inc. in Arizona. One payment. No subscription. No cut of your claim.
Oscar Health Plan, Inc. inside Arizona
Your denial did not happen in a national average. It happened in a state market, alongside 6 other insurers reporting into the same federal file, and these are that market's own figures.
- Across the whole of Arizona, the 7 insurers reporting in this file processed 8,988,391 in-network claims and denied 1,449,189 of them, a state denial rate of 16.1%. Oscar Health Plan, Inc. is one of those 7.
- That puts Arizona 16th of 29 states by denial rate, 0.4 points above the 15.7% national average, before you get to what Oscar Health Plan, Inc. did inside it.
- Arizona recorded 11,145 internal appeals against those denials: one appeal for every 130 claims the state's insurers refused. Oscar Health Plan, Inc.'s own ratio is one for every 20.
- Independent external review was reached 294 times in the whole of Arizona, once for every 4,929 denials, against one in 17,061 nationally. 15 of those Arizona filings came from Oscar Health Plan, Inc.'s denials.
- Of the Arizona external reviews that were filed, 61 were overturned, 20.7%. That percentage is measured on 294 reviews, which is why the count beside it matters more than the rate does when you are deciding whether to file against Oscar Health Plan, Inc..
- The reason Arizona's insurers record most often is other reasons, 653,458 claims, 33.9% of the state's categorized denials. Oscar Health Plan, Inc. records administrative reason most often instead, which is the argument your letter will need to answer.
- The other insurers an Arizona reader could have bought from run from 50.1% (Imperial Insurance Companies, Inc.) to 9.5% (Antidote Health Plan of Arizona, Inc.). Oscar Health Plan, Inc. at 17.8% sits between the two.
- Put the two together and Oscar Health Plan, Inc. is responsible for 4.8% of every in-network claim denied in Arizona in this release, from 4.3% of the claims the state's insurers processed.
- Every Arizona figure in this section is that state's own row in the same federal file Oscar Health Plan, 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 Arizona page is free at /states/arizona.
What Oscar Health Plan, Inc. denies most
The most common denial reason recorded for Oscar Health Plan, Inc. plans in Arizona is administrative reason. How that denial is beaten →
| Denial reason | Claims | Share | National share |
|---|---|---|---|
| Administrative reason | 32,619 | 27.1% | 17.2% |
| Other reasons | 29,499 | 24.5% | 32.4% |
| Benefit limit reached | 17,590 | 14.6% | 4.9% |
| Provider out of network | 16,613 | 13.8% | 9% |
| Referral required | 12,503 | 10.4% | 9.6% |
| Service excluded from the plan | 9,715 | 8.1% | 13.4% |
| Member not covered | 1,556 | 1.3% | 7.9% |
| Experimental or investigational | 165 | 0.1% | 0.1% |
| Not medically necessary | 53 | 0% | 5.5% |
The last column is each reason's share of all categorized denials nationally, so you can see where Oscar Health Plan, Inc.'s mix in Arizona 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. For what it is worth on this page specifically: Oscar Health Plan, Inc. overturned 19.72% of the internal appeals it received.
Questions
Is Oscar Health Plan, Inc.'s denial rate in Arizona high?
17.8% against a national average of 15.7% across the plans in this dataset. It is above average. A denial rate describes the insurer, not the merits of your claim.
How many people appealed an Oscar Health Plan, Inc. denial in Arizona, and how many won?
3,448 internal appeals were filed against 69,003 denials, and 19.72% of them were overturned (680 claims). 15 went on to independent external review.
How does Oscar Health Plan, Inc. compare with other insurers in Arizona?
Of the 6 insurers in Arizona with a reported denial rate, Oscar Health Plan, Inc. ranks 3 highest at 17.8%. The highest in Arizona is Imperial Insurance Companies, Inc. at 50.1%; the lowest is Antidote Health Plan of Arizona, Inc. at 9.5%.
What does Oscar Health Plan, Inc. deny most often in Arizona?
Administrative reason, 32,619 claims, 27.1% of this issuer's categorized denials, against 17.2% nationally. This is the denial-reason mix; the federal file does not report overturn rates by reason.
How long do I have to appeal an Oscar Health Plan, Inc. denial in Arizona?
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 Arizona, Oscar 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 an Oscar Health Plan, Inc. denial in Arizona cost anything?
The internal appeal to Oscar 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 Arizona can be charged more than that to file one.
Can Oscar Health Plan, Inc. ignore an external review decision in Arizona?
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 15 external reviews recorded against 69,003 Oscar Health Plan, Inc. denials in Arizona the striking number on this page.
Oscar Health Plan, Inc. sits at 17.8% in Arizona against 15.7% nationally, and that is the whole of what this page can honestly tell you about your own claim. 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 Oscar Health Plan, Inc. appeal in Arizona: 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 Oscar Health Plan, Inc. figures on this page, the 17.8% denial rate, the 69,003 denials and the 15 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).