Oscar Insurance Company claim denials in Missouri: the federal figures
Oscar Insurance Company denied 12.1% of in-network claims in Missouri — 17,164 claims out of 141,734. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Oscar Insurance Company) | 174 | 52.9% |
| External review (independent) | — | — |
What Oscar Insurance Company denies most
The most common denial reason recorded for Oscar Insurance Company plans in Missouri is administrative reason. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Administrative reason | 7,104 | 37.4% |
| Service excluded from the plan | 4,431 | 23.3% |
| Benefit limit reached | 3,270 | 17.2% |
| Provider out of network | 1,825 | 9.6% |
| Referral required | 1,277 | 6.7% |
| Other reasons | 567 | 3% |
| Not medically necessary | 512 | 2.7% |
What to do if Oscar Insurance Company 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 Insurance Company overturned 52.9% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Oscar Insurance Company. 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 Insurance Company 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 Insurance Company's denial rate high?
12.1% 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 Insurance Company ignore the external decision?
No. External review decisions are binding on the plan.