University of Utah Health Insurance Plans claim denials in Utah: the federal figures
University of Utah Health Insurance Plans denied 20.9% of in-network claims in Utah — 112,076 claims out of 535,566. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to University of Utah Health Insurance Plans) | 532 | 35.5% |
| External review (independent) | 15 | — |
What University of Utah Health Insurance Plans denies most
The most common denial reason recorded for University of Utah Health Insurance Plans plans in Utah is administrative reason. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Administrative reason | 12,506 | 46.3% |
| Other reasons | 5,434 | 20.1% |
| Referral required | 2,582 | 9.6% |
| Member not covered | 2,158 | 8% |
| Service excluded from the plan | 2,059 | 7.6% |
| Provider out of network | 1,082 | 4% |
| Benefit limit reached | 525 | 1.9% |
| Not medically necessary | 493 | 1.8% |
| Experimental or investigational | 197 | 0.7% |
What to do if University of Utah Health Insurance Plans 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. University of Utah Health Insurance Plans overturned 35.5% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not University of Utah Health Insurance Plans. 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 University of Utah Health Insurance Plans 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 University of Utah Health Insurance Plans's denial rate high?
20.9% 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 University of Utah Health Insurance Plans ignore the external decision?
No. External review decisions are binding on the plan.