Premera Blue Cross Blue Shield of Alaska claim denials in Alaska: the federal figures
Premera Blue Cross Blue Shield of Alaska denied 24.1% of in-network claims in Alaska — 166,188 claims out of 689,988. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Premera Blue Cross Blue Shield of Alaska) | 271 | 47.2% |
| External review (independent) | — | — |
What Premera Blue Cross Blue Shield of Alaska denies most
The most common denial reason recorded for Premera Blue Cross Blue Shield of Alaska plans in Alaska is other reasons. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Other reasons | 216,262 | 80.4% |
| Referral required | 23,638 | 8.8% |
| Service excluded from the plan | 21,978 | 8.2% |
| Administrative reason | 2,815 | 1% |
| Member not covered | 2,403 | 0.9% |
| Not medically necessary | 1,171 | 0.4% |
| Provider out of network | 577 | 0.2% |
| Benefit limit reached | 71 | 0% |
| Experimental or investigational | 44 | 0% |
What to do if Premera Blue Cross Blue Shield of Alaska 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. Premera Blue Cross Blue Shield of Alaska overturned 47.2% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Premera Blue Cross Blue Shield of Alaska. 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 Premera Blue Cross Blue Shield of Alaska 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 Premera Blue Cross Blue Shield of Alaska's denial rate high?
24.1% against a national average of 16% across the plans in this dataset. It is above 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 Premera Blue Cross Blue Shield of Alaska ignore the external decision?
No. External review decisions are binding on the plan.