Oscar denied your claim in Texas. Here is your deadline.
Put in the date on your Oscar Insurance Company notice and get both federal deadlines as calendar dates.
Free, for an Oscar Insurance Company denial in Texas, 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 Insurance Company denied 764,285 of 3,001,076 in-network claims in Texas; every one of those denials had these same two dates on it. Across Texas as a whole the insurers in this file denied 18.5% of in-network claims, 22,372,063 of them, and 90,241 were appealed.
Oscar Insurance Company denied 25.5% of in-network claims in Texas, 764,285 claims out of 3,001,076.
Insurance got denied, what to do next?
Those 764,285 denials are 3.4% of every in-network denial recorded in Texas in this release, which makes Oscar Insurance Company the 8th largest source of denials of the 14 insurers reporting there. Spread across its 100 plans in the state that is about 7,643 denials per plan. 38,325 internal appeals were filed against those 764,285 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 Texas 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: 764,285 in-network claims were denied by Oscar Insurance Company in Texas 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 14 insurers reporting a denial rate in Texas, Oscar Insurance Company is the third highest at 25.5%. The highest in the state is 35.7% and the lowest is 11.7%.
- That is 6.8 percentage points above the 18.7% national average across this dataset, and 7 points above the Texas average of 18.5%.
- Behind the percentage: 3,001,076 in-network claims were processed under 100 plans in Texas, and 764,285 of them came back denied.
- For every 10,000 claims Oscar Insurance Company denied, about 501 came back as an internal appeal. The other 9,499 stopped at the letter.
- Of the internal appeals it did receive, Oscar Insurance Company overturned 23.64%, 9,061 claims that started life as a no.
- 517 of those denials went on to independent external review, the stage whose decision the plan is required by law to accept. Nationally 32.8% of external reviews are overturned.
- Its most-recorded denial reason is administrative reason at 61% of its categorized denials, against 22.5% nationally, a heavier share than the country as a whole. That is the denial mix, not an outcome rate.
- In Texas, Oscar Insurance Company reported 25.5%, and the same company files in 8 other states in this file, where the rate is not the same in any of them: 28.1% in Arizona, 27.3% in Michigan, 26.1% in Kansas, down to 21.7% in Nebraska. Which state the plan was bought in moves the odds more than the brand on the card does.
- Oscar Insurance Company accounts for 3.4% of every in-network claim denied in Texas in this file.
- By raw volume it is the 27th largest source of denials among the 158 insurer-state records in the file that report one.
- Put another way: one independent external review was filed for every 1,478 claims Oscar Insurance Company denied in Texas.
- After that, its second-most-recorded reason is benefit limit reached, 105,695 claims, 12.6% of its categorized denials.
- Third on its own list is referral required, 97,583 claims, 11.6% of what Oscar Insurance Company categorized in Texas. Between them the top three account for 85.1% of its categorized denials.
- Where Oscar Insurance Company differs most from the national mix is administrative reason: 61% of its categorized denials in Texas against 22.5% across the file.
- Read the other way round: 2,236,791 of those 3,001,076 in-network claims were paid, 74.5% of everything Oscar Insurance Company processed in Texas.
- Spread across the 100 plans it reports in Texas, that is about 7,643 denied claims per plan, on about 30,011 claims processed per plan.
- Its reason columns add up to 842,007 categorized rows against 764,285 denials, 110.2% 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 Texas is not medically necessary, 173 claims, 0% of what Oscar Insurance Company categorized there.
- Against the file as a whole, this one record is 0.9% of the 84,502,749 in-network claim denials reported by every issuer in it.
- Find the reason code on your denial letter. The reason Oscar Insurance Company records most often in Texas 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 Insurance Company in Texas 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 Insurance Company overturned 23.64% of the internal appeals it did receive, 9,061 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 Insurance Company | 25.5% | , |
| Texas average | 18.5% | +7 pts |
| National average (this dataset) | 18.7% | +6.8 pts |
Oscar Insurance Company denies 6.8 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 Insurance Company) | 38,325 | 23.64% |
| External review (independent) | 517 | 34.04% |
The gap nobody escalated
764,285 claims denied. 38,325 internal appeals filed. 517 reached independent external review. Nationally 32.8% 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 Insurance Company letter, and by when. Oscar Insurance Company overturned 23.64% of the 38,325 internal appeals its Texas members filed against 764,285 denials, and 517 of those Texas denials went on to the independent stage whose decision binds the plan, Oscar Insurance Company's own rows in the plan-year 2026 release of the CMS Transparency in Coverage file, read September 5, 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 60 calendar days after you receive its notice (42 CFR 422.582(b)) and Medicaid managed care the same 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 Insurance Company 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 Insurance Company in Texas. One payment. No subscription. No cut of your claim.
Oscar Insurance Company inside Texas
Your denial did not happen in a national average. It happened in a state market, alongside 17 other insurers reporting into the same federal file, and these are that market's own figures.
- Across the whole of Texas, the 18 insurers reporting in this file processed 120,606,438 in-network claims and denied 22,372,063 of them, a state denial rate of 18.5%. Oscar Insurance Company is one of those 18.
- That puts Texas 14th of 30 states by denial rate, 0.2 points below the 18.7% national average, before you get to what Oscar Insurance Company did inside it.
- Texas recorded 90,241 internal appeals against those denials: one appeal for every 248 claims the state's insurers refused. Oscar Insurance Company's own ratio is one for every 20.
- Independent external review was reached 1,908 times in the whole of Texas, once for every 11,725 denials, against one in 14,369 nationally. 517 of those Texas filings came from Oscar Insurance Company's denials.
- Of the Texas external reviews that were filed, 849 were overturned, 44.5%. That percentage is measured on 1,908 reviews, which is why the count beside it matters more than the rate does when you are deciding whether to file against Oscar Insurance Company.
- The reason Texas's insurers record most often is other reasons, 9,919,256 claims, 38.7% of the state's categorized denials. Oscar Insurance Company records administrative reason most often instead, which is the argument your letter will need to answer.
- The other insurers a Texas reader could have bought from run from 35.7% (Imperial Insurance Companies, Inc.) to 11.7% (CHRISTUS Health Plan). Oscar Insurance Company at 25.5% sits between the two.
- Put the two together and Oscar Insurance Company is responsible for 3.4% of every in-network claim denied in Texas in this release, from 2.5% of the claims the state's insurers processed.
- Every Texas figure in this section is that state's own row in the same federal file Oscar Insurance Company's numbers above come from, CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 claims), data.healthcare.gov — US Government public domain, and the full Texas page is free at /states/texas.
What Oscar Insurance Company denies most
The most common denial reason recorded for Oscar Insurance Company plans in Texas is administrative reason. How that denial is beaten →
| Denial reason | Claims | Share | National share |
|---|---|---|---|
| Administrative reason | 513,522 | 61% | 22.5% |
| Benefit limit reached | 105,695 | 12.6% | 4.2% |
| Referral required | 97,583 | 11.6% | 8.4% |
| Provider out of network | 77,617 | 9.2% | 9.8% |
| Other reasons | 19,106 | 2.3% | 32.3% |
| Service excluded from the plan | 13,237 | 1.6% | 11.6% |
| Member not covered | 13,147 | 1.6% | 6.6% |
| Experimental or investigational | 1,927 | 0.2% | 0.1% |
| Not medically necessary | 173 | 0% | 4.6% |
The last column is each reason's share of all categorized denials nationally, so you can see where Oscar Insurance Company's mix in Texas 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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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 Insurance Company overturned 23.64% of the internal appeals it received.
Questions
Is Oscar Insurance Company's denial rate in Texas high?
25.5% against a national average of 18.7% 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 Insurance Company denial in Texas, and how many won?
38,325 internal appeals were filed against 764,285 denials, and 23.64% of them were overturned (9,061 claims). 517 went on to independent external review.
How does Oscar Insurance Company compare with other insurers in Texas?
Of the 14 insurers in Texas with a reported denial rate, Oscar Insurance Company ranks 3 highest at 25.5%. The highest in Texas is Imperial Insurance Companies, Inc. at 35.7%; the lowest is CHRISTUS Health Plan at 11.7%.
What does Oscar Insurance Company deny most often in Texas?
Administrative reason, 513,522 claims, 61% of this issuer's categorized denials, against 22.5% 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 Insurance Company denial in Texas?
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 Texas, Oscar Insurance Company 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 Insurance Company denial in Texas cost anything?
The internal appeal to Oscar Insurance Company 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 Texas can be charged more than that to file one.
Can Oscar Insurance Company ignore an external review decision in Texas?
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 517 external reviews recorded against 764,285 Oscar Insurance Company denials in Texas the striking number on this page.
Oscar Insurance Company sits at 25.5% in Texas against 18.7% nationally, and that is the whole of what this page can honestly tell you about your own claim. I am 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 me and I will correct the page.
, Andrew at Axion Labs · hello@getaxionlabs.comEverything you need for your Oscar Insurance Company appeal in Texas: your two deadlines, the argument that fits your denial reason, the letters, the clinician brief, 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 Insurance Company figures on this page, the 25.5% denial rate, the 764,285 denials and the 517 external reviews, are this issuer’s own reported rows in that file.
Counts: CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 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).