Sendero Health Plans, Inc. claim denials in Texas: the federal figures
Sendero Health Plans, Inc. denied 29.1% of in-network claims in Texas — 83,908 claims out of 288,610. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Sendero Health Plans, Inc.) | 26 | — |
| External review (independent) | — | — |
What Sendero Health Plans, Inc. denies most
The most common denial reason recorded for Sendero Health Plans, Inc. plans in Texas is other reasons. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Other reasons | 76,485 | 85.8% |
| Service excluded from the plan | 7,017 | 7.9% |
| Referral required | 4,397 | 4.9% |
| Member not covered | 665 | 0.7% |
| Administrative reason | 390 | 0.4% |
| Provider out of network | 189 | 0.2% |
What to do if Sendero Health Plans, 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.
- If they say no again, go external. An independent organization reviews it — not Sendero Health Plans, 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 Sendero Health Plans, 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 Sendero Health Plans, Inc.'s denial rate high?
29.1% 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 Sendero Health Plans, Inc. ignore the external decision?
No. External review decisions are binding on the plan.