Paramount Insurance Company claim denials in Ohio: the federal figures
Paramount Insurance Company denied 14.2% of in-network claims in Ohio — 15,017 claims out of 106,069. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Paramount Insurance Company) | 29 | 72.4% |
| External review (independent) | — | — |
What Paramount Insurance Company denies most
The most common denial reason recorded for Paramount Insurance Company plans in Ohio is service excluded from the plan. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Service excluded from the plan | 13,018 | 33.5% |
| Benefit limit reached | 9,824 | 25.2% |
| Administrative reason | 5,559 | 14.3% |
| Other reasons | 4,537 | 11.7% |
| Provider out of network | 2,907 | 7.5% |
| Referral required | 2,342 | 6% |
| Member not covered | 628 | 1.6% |
| Experimental or investigational | 65 | 0.2% |
| Not medically necessary | 37 | 0.1% |
What to do if Paramount 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. Paramount Insurance Company overturned 72.4% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Paramount 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 Paramount 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 Paramount Insurance Company's denial rate high?
14.2% 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 Paramount Insurance Company ignore the external decision?
No. External review decisions are binding on the plan.