Summa Insurance Company, Inc. claim denials in Ohio: the federal figures
Summa Insurance Company, Inc. denied 22.7% of in-network claims in Ohio — 44,158 claims out of 194,475. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Summa Insurance Company, Inc.) | 170 | 67.1% |
| External review (independent) | — | — |
What Summa Insurance Company, Inc. denies most
The most common denial reason recorded for Summa Insurance Company, Inc. plans in Ohio is other reasons. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Other reasons | 17,479 | 47.8% |
| Referral required | 10,436 | 28.6% |
| Not medically necessary | 4,683 | 12.8% |
| Member not covered | 2,201 | 6% |
| Administrative reason | 842 | 2.3% |
| Service excluded from the plan | 818 | 2.2% |
| Benefit limit reached | 82 | 0.2% |
What to do if Summa 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. Summa Insurance Company, Inc. overturned 67.1% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Summa 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 Summa 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 Summa Insurance Company, Inc.'s denial rate high?
22.7% 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 Summa Insurance Company, Inc. ignore the external decision?
No. External review decisions are binding on the plan.