Wellmark Health Plan of Iowa, Inc. claim denials in Iowa: the federal figures
Wellmark Health Plan of Iowa, Inc. denied 16% of in-network claims in Iowa — 306,763 claims out of 1,919,981. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Wellmark Health Plan of Iowa, Inc.) | — | — |
| External review (independent) | — | — |
What Wellmark Health Plan of Iowa, Inc. denies most
The most common denial reason recorded for Wellmark Health Plan of Iowa, Inc. plans in Iowa is other reasons. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Other reasons | 176,857 | 38.6% |
| Administrative reason | 128,946 | 28.1% |
| Referral required | 40,235 | 8.8% |
| Service excluded from the plan | 39,118 | 8.5% |
| Benefit limit reached | 33,230 | 7.2% |
| Member not covered | 24,122 | 5.3% |
| Not medically necessary | 13,235 | 2.9% |
| Experimental or investigational | 2,987 | 0.7% |
What to do if Wellmark Health Plan of Iowa, 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 Wellmark Health Plan of Iowa, 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 Wellmark Health Plan of Iowa, 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 Wellmark Health Plan of Iowa, Inc.'s denial rate high?
16% 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 Wellmark Health Plan of Iowa, Inc. ignore the external decision?
No. External review decisions are binding on the plan.