QualChoice Life & Health Insurance Company, Inc. claim denials in Arkansas: the federal figures
QualChoice Life & Health Insurance Company, Inc. denied 12.5% of in-network claims in Arkansas — 276,111 claims out of 2,217,520. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to QualChoice Life & Health Insurance Company, Inc.) | 161 | 44.1% |
| External review (independent) | — | — |
What QualChoice Life & Health Insurance Company, Inc. denies most
The most common denial reason recorded for QualChoice Life & Health Insurance Company, Inc. plans in Arkansas is administrative reason. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Administrative reason | 143,501 | 29.6% |
| Service excluded from the plan | 106,015 | 21.9% |
| Other reasons | 67,924 | 14% |
| Referral required | 59,518 | 12.3% |
| Benefit limit reached | 58,419 | 12.1% |
| Not medically necessary | 32,789 | 6.8% |
| Member not covered | 12,190 | 2.5% |
| Provider out of network | 3,656 | 0.8% |
What to do if QualChoice Life & Health Insurance Company, Inc. 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. QualChoice Life & Health Insurance Company, Inc. overturned 44.1% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not QualChoice Life & Health Insurance Company, Inc.. 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 QualChoice Life & Health Insurance Company, Inc. 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 QualChoice Life & Health Insurance Company, Inc.'s denial rate high?
12.5% 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 QualChoice Life & Health Insurance Company, Inc. ignore the external decision?
No. External review decisions are binding on the plan.