Oscar Health Plan of North Carolina denied your claim. Here is your deadline.
Put in the date on your Oscar Health Plan of North Carolina, Inc notice and get both federal deadlines as calendar dates.
Free, for an Oscar Health Plan of North Carolina, Inc denial in North Carolina, 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 of North Carolina, Inc denied 25,387 of 198,147 in-network claims in North Carolina; every one of those denials had these same two dates on it. Across North Carolina as a whole the insurers in this file denied 19.7% of in-network claims, 5,857,465 of them, and 6,532 were appealed.
Or let the $29 Appeal Kit date each step and write the claim-file and external-review requests.
Oscar Health Plan of North Carolina, Inc denied 12.8% of in-network claims in North Carolina, 25,387 claims out of 198,147.
Further down this page, after the free steps: the paid next step.
Insurance got denied, what to do next?
Those 25,387 denials are 0.4% of every in-network denial recorded in North Carolina in this release, which makes Oscar Health Plan of North Carolina, Inc the 5th largest source of denials of the 5 insurers reporting there. Spread across its 28 plans in the state that is about 907 denials per plan. 1,520 internal appeals were filed against those 25,387 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 North Carolina 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: 25,387 in-network claims were denied by Oscar Health Plan of North Carolina, Inc in North Carolina 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 5 insurers reporting a denial rate in North Carolina, Oscar Health Plan of North Carolina, Inc is the fourth highest at 12.8%. The highest in the state is 26.2% and the lowest is 12.2%.
- That is 2.9 percentage points below the 15.7% national average across this dataset, and 6.9 points below the North Carolina average of 19.7%.
- Behind the percentage: 198,147 in-network claims were processed under 28 plans in North Carolina, and 25,387 of them came back denied.
- For every 10,000 claims Oscar Health Plan of North Carolina, Inc denied, about 599 came back as an internal appeal. The other 9,401 stopped at the letter.
- Of the internal appeals it did receive, Oscar Health Plan of North Carolina, Inc overturned 19.54%, 297 claims that started life as a no.
- 21 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 provider out of network at 47.1% of its categorized denials, against 9% nationally, a heavier share than the country as a whole. That is the denial mix, not an outcome rate.
- Oscar Health Plan of North Carolina, Inc accounts for 0.4% of every in-network claim denied in North Carolina in this file.
- By raw volume it is the 109th 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 1,209 claims Oscar Health Plan of North Carolina, Inc denied in North Carolina.
- After that, its second-most-recorded reason is administrative reason, 10,961 claims, 36.6% of its categorized denials.
- Third on its own list is other reasons, 2,609 claims, 8.7% of what Oscar Health Plan of North Carolina, Inc categorized in North Carolina. Between them the top three account for 92.4% of its categorized denials.
- Where Oscar Health Plan of North Carolina, Inc differs most from the national mix is provider out of network: 47.1% of its categorized denials in North Carolina against 9% across the file.
- Read the other way round: 172,760 of those 198,147 in-network claims were paid, 87.2% of everything Oscar Health Plan of North Carolina, Inc processed in North Carolina.
- Spread across the 28 plans it reports in North Carolina, that is about 907 denied claims per plan, on about 7,077 claims processed per plan.
- Its reason columns add up to 29,920 categorized rows against 25,387 denials, 117.9% 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 North Carolina is member not covered, 30 claims, 0.1% of what Oscar Health Plan of North Carolina, Inc categorized there.
- Against the file as a whole, this one record is 0% 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 of North Carolina, Inc records most often in North Carolina is provider out of network, 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 of North Carolina, Inc in North Carolina 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 of North Carolina, Inc overturned 19.54% of the internal appeals it did receive, 297 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 of North Carolina, Inc | 12.8% | , |
| North Carolina average | 19.7% | -6.9 pts |
| National average (this dataset) | 15.7% | -2.9 pts |
Oscar Health Plan of North Carolina, 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 Oscar Health Plan of North Carolina, Inc) | 1,520 | 19.54% |
| External review (independent) | 21 | not reported |
The gap nobody escalated
25,387 claims denied. 1,520 internal appeals filed. 21 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 of North Carolina, Inc letter, and by when. Oscar Health Plan of North Carolina, Inc overturned 19.54% of the 1,520 internal appeals its North Carolina members filed against 25,387 denials, and 21 of those North Carolina denials went on to the independent stage whose decision binds the plan, Oscar Health Plan of North Carolina, 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 of North Carolina, 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 of North Carolina, Inc in North Carolina. One payment. No subscription. No cut of your claim.
Oscar Health Plan of North Carolina, Inc inside North Carolina
Your denial did not happen in a national average. It happened in a state market, alongside 4 other insurers reporting into the same federal file, and these are that market's own figures.
- Across the whole of North Carolina, the 5 insurers reporting in this file processed 29,684,141 in-network claims and denied 5,857,465 of them, a state denial rate of 19.7%. Oscar Health Plan of North Carolina, Inc is one of those 5.
- That puts North Carolina sixth of 29 states by denial rate, 4 points above the 15.7% national average, before you get to what Oscar Health Plan of North Carolina, Inc did inside it.
- North Carolina recorded 6,532 internal appeals against those denials: one appeal for every 897 claims the state's insurers refused. Oscar Health Plan of North Carolina, Inc's own ratio is one for every 17.
- Independent external review was reached 121 times in the whole of North Carolina, once for every 48,409 denials, against one in 17,061 nationally. 21 of those North Carolina filings came from Oscar Health Plan of North Carolina, Inc's denials.
- Of the North Carolina external reviews that were filed, 54 were overturned, 44.6%. That percentage is measured on 121 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 of North Carolina, Inc.
- The reason North Carolina's insurers record most often is other reasons, 2,323,043 claims, 36.1% of the state's categorized denials. Oscar Health Plan of North Carolina, Inc records provider out of network most often instead, which is the argument your letter will need to answer.
- The other insurers a North Carolina reader could have bought from run from 26.2% (AmeriHealth Caritas North Carolina, Inc.) to 12.2% (Ambetter of North Carolina Inc.). Oscar Health Plan of North Carolina, Inc at 12.8% sits between the two.
- Put the two together and Oscar Health Plan of North Carolina, Inc is responsible for 0.4% of every in-network claim denied in North Carolina in this release, from 0.7% of the claims the state's insurers processed.
- Every North Carolina figure in this section is that state's own row in the same federal file Oscar Health Plan of North Carolina, 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 North Carolina page is free at /states/north-carolina.
What Oscar Health Plan of North Carolina, Inc denies most
The most common denial reason recorded for Oscar Health Plan of North Carolina, Inc plans in North Carolina is provider out of network. How that denial is beaten →
| Denial reason | Claims | Share | National share |
|---|---|---|---|
| Provider out of network | 14,079 | 47.1% | 9% |
| Administrative reason | 10,961 | 36.6% | 17.2% |
| Other reasons | 2,609 | 8.7% | 32.4% |
| Service excluded from the plan | 1,258 | 4.2% | 13.4% |
| Referral required | 877 | 2.9% | 9.6% |
| Experimental or investigational | 62 | 0.2% | 0.1% |
| Benefit limit reached | 44 | 0.1% | 4.9% |
| Member not covered | 30 | 0.1% | 7.9% |
The last column is each reason's share of all categorized denials nationally, so you can see where Oscar Health Plan of North Carolina, Inc's mix in North Carolina 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.
Runs entirely in your browser, the date you type is never sent to us and never stored. Open the full calculator →
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 of North Carolina, Inc overturned 19.54% of the internal appeals it received.
Questions
Is Oscar Health Plan of North Carolina, Inc's denial rate in North Carolina high?
12.8% against a national average of 15.7% 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 an Oscar Health Plan of North Carolina, Inc denial in North Carolina, and how many won?
1,520 internal appeals were filed against 25,387 denials, and 19.54% of them were overturned (297 claims). 21 went on to independent external review.
How does Oscar Health Plan of North Carolina, Inc compare with other insurers in North Carolina?
Of the 5 insurers in North Carolina with a reported denial rate, Oscar Health Plan of North Carolina, Inc ranks 4 highest at 12.8%. The highest in North Carolina is AmeriHealth Caritas North Carolina, Inc. at 26.2%; the lowest is Ambetter of North Carolina Inc. at 12.2%.
What does Oscar Health Plan of North Carolina, Inc deny most often in North Carolina?
Provider out of network, 14,079 claims, 47.1% of this issuer's categorized denials, against 9% 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 of North Carolina, Inc denial in North Carolina?
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 North Carolina, Oscar Health Plan of North Carolina, 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 of North Carolina, Inc denial in North Carolina cost anything?
The internal appeal to Oscar Health Plan of North Carolina, 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 North Carolina can be charged more than that to file one.
Can Oscar Health Plan of North Carolina, Inc ignore an external review decision in North Carolina?
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 21 external reviews recorded against 25,387 Oscar Health Plan of North Carolina, Inc denials in North Carolina the striking number on this page.
Oscar Health Plan of North Carolina, Inc sits at 12.8% in North Carolina 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 of North Carolina, Inc appeal in North Carolina: 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 of North Carolina, Inc figures on this page, the 12.8% denial rate, the 25,387 denials and the 21 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).