Quartz Health Benefit Plans Corporation claim denials in Illinois: the federal figures
Quartz Health Benefit Plans Corporation denied 10.6% of in-network claims in Illinois — 7,481 claims out of 70,893. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Quartz Health Benefit Plans Corporation) | 18 | — |
| External review (independent) | — | 100% |
What Quartz Health Benefit Plans Corporation denies most
The most common denial reason recorded for Quartz Health Benefit Plans Corporation plans in Illinois is administrative reason. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Administrative reason | 3,091 | 88% |
| Service excluded from the plan | 223 | 6.4% |
| Referral required | 186 | 5.3% |
| Provider out of network | 11 | 0.3% |
What to do if Quartz Health Benefit Plans Corporation 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.
- If they say no again, go external. An independent organization reviews it — not Quartz Health Benefit Plans Corporation. 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 Quartz Health Benefit Plans Corporation 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 Quartz Health Benefit Plans Corporation's denial rate high?
10.6% 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 Quartz Health Benefit Plans Corporation ignore the external decision?
No. External review decisions are binding on the plan.