Security Health Plan of Wisconsin, Inc. claim denials in Wisconsin: the federal figures
Security Health Plan of Wisconsin, Inc. denied 8.9% of in-network claims in Wisconsin — 65,095 claims out of 728,690. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Security Health Plan of Wisconsin, Inc.) | 140 | 65.7% |
| External review (independent) | — | — |
What Security Health Plan of Wisconsin, Inc. denies most
The most common denial reason recorded for Security Health Plan of Wisconsin, Inc. plans in Wisconsin is other reasons. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Other reasons | 88,876 | 82.1% |
| Administrative reason | 10,654 | 9.8% |
| Provider out of network | 3,199 | 3% |
| Service excluded from the plan | 1,725 | 1.6% |
| Referral required | 1,647 | 1.5% |
| Member not covered | 1,564 | 1.4% |
| Not medically necessary | 552 | 0.5% |
| Experimental or investigational | 22 | 0% |
What to do if Security Health Plan of Wisconsin, 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. Security Health Plan of Wisconsin, Inc. overturned 65.7% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Security Health Plan of Wisconsin, 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 Security Health Plan of Wisconsin, 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 Security Health Plan of Wisconsin, Inc.'s denial rate high?
8.9% 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 Security Health Plan of Wisconsin, Inc. ignore the external decision?
No. External review decisions are binding on the plan.