---
title: "Missouri: who to call about a denied health claim"
url: "https://denialfacts.com/states/missouri"
publisher: "Axion Labs — Denial Facts"
checked: "2026-11-04"
dataset_fixity: "sha256-cda2f9b89c8dde2a74989a35dbe7c0d08ff35dac5456484dc1c03c1b181a67b6"
---

# Denied in Missouri? Here is the phone number, then the date.

Insurers in Missouri denied 1,592,551 in-network claims (11.7%), plan-year 2027 release, issued October 22, 2026.

## Figures

| Figure | Value |
| --- | --- |
| Claims denied | 1,592,551 |
| Denial rate | 11.7% |
| Insurers reporting | 6 |
| External reviews filed | 12 |
| External overturn rate | 0% |
| National denial rate | 15.7% |

## External-review route

**State-run process.** Missouri runs its own external review process meeting the federal standards, so an independent review there is handled through the state program rather than the federal one. This route is the one for insured plans, Marketplace, individual, and employer plans where an insurance company carries the risk. If your coverage is through a job and the employer pays the claims itself (a self-funded or self-insured plan, which is 63% of covered workers), the state process does not apply to you whatever your state operates, and your external review goes through the federal process instead. Your denial letter names your route; if it does not, ask your plan in writing whether the plan is self-funded.

## Insurers in Missouri, with each one's page

| Insurer | Denial rate | Claims denied | External reviews | Page |
| --- | --- | --- | --- | --- |
| Blue Cross and Blue Shield of Kansas City | 24.5% | 26,133 | 0 | https://denialfacts.com/insurers/blue-cross-and-blue-shield-of-kansas-city--mo |
| Medica Insurance Company | 20.5% | 127,628 | 0 | https://denialfacts.com/insurers/medica-insurance-company--mo |
| UnitedHealthcare Insurance Company | 19.2% | 220,146 | 0 | https://denialfacts.com/insurers/unitedhealthcare-insurance-company--mo |
| Oscar Insurance Company | 18.4% | 64,953 | 12 | https://denialfacts.com/insurers/oscar-insurance-company--mo |
| Celtic Insurance Company | 10.9% | 981,732 | 0 | https://denialfacts.com/insurers/celtic-insurance-company--mo |
| Healthy Alliance Life Insurance Company | 7.3% | 171,959 | 0 | https://denialfacts.com/insurers/healthy-alliance-life-insurance-company--mo |

## Missouri, at the top of the page

Missouri

Before you write anything, call this free number: 800-726-7390 , the Missouri consumer service that takes your side.

Your two dates, free

Date on your denial notice

Who pays your claims?

A job, an insurance company pays the claims

A job, my employer pays the claims itself (self-funded)

A job, I do not know which

Marketplace / individual plan I bought myself

Medicare, Medicaid, TRICARE, VA or IHS

Which state?

The reason your letter gives

I'm not sure, I'll paste the sentence later

Not medically necessary
Provider out of network
Service excluded from the plan
Experimental or investigational
Referral required
Benefit limit reached
Member not covered
Administrative reason
Other reasons

Show my two dates, free

Put in the date on your notice and get both federal deadlines as calendar dates.

Free, for a denial in Missouri, and it runs entirely in your browser. The date, the plan type and the state you pick are never sent to us and never stored.

It also tells you whether your external review goes to Missouri or to the federal process, the part that is not the same in every state.

The Missouri consumer service can tell you whether your external review goes to the state or to the federal process, and in some cases it will file for you. That call costs nothing and does not use up your 180 days. The complaint form is [here](https://insurance.mo.gov/consumer-complaints/insurance-complaints) .

Read from [insurance.mo.gov](https://insurance.mo.gov/about-department/contact-us) on September 9, 2026. If the number has changed, tell us and we will fix it the same day.

Insurers in Missouri denied 1,592,551 in-network claims in this release, 11.7% of everything submitted.

Further down this page, after the free steps: the paid next step .

Insurance company denied claim. What do we do?

We hear this most. [r/personalfinance, thread title](https://www.reddit.com/r/personalfinance/comments/svx5ha/insurance_company_denied_claim_what_do_we_do/) , read September 3, 2026.

By [Axion Labs](/about) · August 19, 2026, updated November 4, 2026

Those are the plan-year 2027 release figures, from the federal Transparency in Coverage file issued October 22, 2026. Just 12 of those Missouri denials reached independent external review, and 0% of those were overturned.

The clock your letter has to describe, in actual dates

The deadlines are federal, so they are the same in every state. You have 180 days from the date on your denial notice to file the internal appeal, and then 4 months from the final internal denial to ask for an independent external review. If waiting would seriously jeopardize your health you can ask for both to be expedited, decided in about 72 hours . Both timeframes are federal, not your insurer's choice, [29 CFR 2560.503-1](https://www.ecfr.gov/current/title-29/section-2560.503-1) ( [PDF](https://www.govinfo.gov/content/pkg/CFR-2024-title29-vol9/pdf/CFR-2024-title29-vol9-sec2560-503-1.pdf) ) and [45 CFR 147.136](https://www.ecfr.gov/current/title-45/section-147.136) ( [PDF](https://www.govinfo.gov/content/pkg/CFR-2024-title45-vol2/pdf/CFR-2024-title45-vol2-sec147-136.pdf) ), in plain English at [HealthCare.gov](https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/) , and your own denial letter states the ones that govern your plan. The PDFs are the same sections on govinfo.gov, which serves them without a challenge page, so an automated reader can check these two dates as easily as you can.

Data verified November 4, 2026 · CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 claims), data.healthcare.gov — US Government public domain

You are not alone in this, and it can be measured: insurers in Missouri denied 1,592,551 in-network claims in a single plan year across 6 reporting insurers. Of those denials, 12 reached the one stage whose decision the insurer has to obey.

- Among the 29 states in the federal file, Missouri has the 24th highest denial rate at 11.7%, against a national 15.7%.

- Which insurer you happen to be with matters more here than the state average does: inside Missouri the reported rates run from 24.5% (Blue Cross and Blue Shield of Kansas City) down to 7.3% (Healthy Alliance Life Insurance Company).

- For every 10,000 claims denied in Missouri, about 23 came back as an internal appeal.

- Of 1,592,551 denials, 12 reached independent external review, about 7.5 for every million denied claims.

- The reason recorded most often in Missouri is other reasons , 18.3% of its categorized denials against 32.4% nationally.

What to do tonight

- Find the reason code on your denial letter. Whichever of the 6 insurers reporting in Missouri sent it, the notice has to state the specific reason and the plan provision behind it. Copy both onto paper tonight.

- Ask your insurer for the clinical criteria they judged you against. Under [29 CFR 2560.503-1](https://www.ecfr.gov/current/title-29/section-2560.503-1) they have to hand you the claim file and the policy they applied, free, on request, and you cannot argue with a checklist you have never read.

- Put both deadlines on your calendar before you go to bed. 180 days from the date on the letter for the internal appeal, 4 months from the final internal denial for external review. The free calculator on this page turns your date into the two calendar dates in about ten seconds. 12 external reviews were filed in Missouri against 1,592,551 denials. Missing the date is what decides whether anyone reads the argument.

None of those three steps costs anything. Anyone charging you to do them is selling you something you can do yourself in twenty minutes.

1,592,551

Claims denied

11.7%

Denial rate

6

Insurers reporting

12

External reviews filed

0%

External overturn rate

Your rights in Missouri are federal. Every non-grandfathered plan must give you an internal appeal, and an independent external review for denials involving medical judgment, experimental or investigational determinations, or rescission of coverage. Your denial letter names the route and the deadline for your plan, that letter is the authority.

External review route in Missouri

State-run process

CMS lists Missouri as running its own external review process that meets the federal standards, so your independent review is handled through the state program rather than the federal one. Source: [the CCIIO state external review table](https://www.cms.gov/CCIIO/Resources/Files/external_appeals) , read August 3, 2026.

This route assumes an insured plan, check before you rely on it. This route is the one for insured plans, Marketplace, individual, and employer plans where an insurance company carries the risk. If your coverage is through a job and the employer pays the claims itself (a self-funded or self-insured plan, which is 63% of covered workers), the state process does not apply to you whatever your state operates, and your external review goes through the federal process instead. Your denial letter names your route; if it does not, ask your plan in writing whether the plan is self-funded. That share is [KFF's 2024 Employer Health Benefits Survey](https://www.kff.org/report-section/ehbs-2024-section-10-plan-funding/) , Section 10.

External review is not always free, but it is capped. There is no charge under the HHS-administered federal process. Where your insurer uses a contracted independent review organization or a state process, a filing fee may apply, but it cannot exceed $25 per review .

What that Missouri external-review count means for your own denial, and by when. 12 independent external reviews were filed in Missouri against 1,592,551 denials, and 0% of them were overturned, Missouri's own rows in the plan-year 2027 release of the CMS Transparency in Coverage file, read November 4, 2026 ( [data.healthcare.gov](https://data.healthcare.gov/) ). Whichever way that lands, nobody files the appeal for you, and the filing runs on a clock set by which plan you hold: an employer or Marketplace plan gives you at least 180 days from the denial notice to file the internal appeal ( [29 CFR 2560.503-1(h)(3)(i)](https://www.govinfo.gov/content/pkg/CFR-2024-title29-vol9/pdf/CFR-2024-title29-vol9-sec2560-503-1.pdf) , carried onto individual-market coverage by [45 CFR 147.136(b)(3)(i)](https://www.govinfo.gov/content/pkg/CFR-2024-title45-vol2/pdf/CFR-2024-title45-vol2-sec147-136.pdf) ), while Medicare Advantage gives you 65 calendar days from the date of its notice ( [CMS](https://www.cms.gov/medicare/appeals-grievances/managed-care/reconsideration-advantage-health-plan-part-c) , [42 CFR 422.582(b)](https://www.ecfr.gov/current/title-42/section-422.582) ) and Medicaid managed care 60 calendar days from the date on the notice ( [42 CFR 438.402(c)(2)(ii)](https://www.ecfr.gov/current/title-42/section-438.402) ), both stages free, and the three steps above are the whole of what to do tonight, and the Missouri route at the end of them is on this page. The consumer line above, the letter and the deadline calculator are all free, and none of them asks for an email.

## Insurers in Missouri

| Insurer | Denial rate | Denied | External reviews |
| --- | --- | --- | --- |
| Blue Cross and Blue Shield of Kansas City | 24.5% | 26,133 | 0 |
| Medica Insurance Company | 20.5% | 127,628 | 0 |
| UnitedHealthcare Insurance Company | 19.2% | 220,146 | 0 |
| Oscar Insurance Company | 18.4% | 64,953 | 12 |
| Celtic Insurance Company | 10.9% | 981,732 | 0 |
| Healthy Alliance Life Insurance Company | 7.3% | 171,959 | 0 |

Work out your two deadlines

Put the date from your notice in and get the two calendar dates, with the days remaining.

Date on your denial notice

Which denial is this?

First denial (I have not appealed yet)

Final internal denial (my appeal was refused)

Show my deadlines

Runs entirely in your browser, the date you type is never sent to us and never stored. [Open the full calculator →](/appeal-deadline-calculator)

## Questions about appealing in Missouri

##### What percentage of health insurance claims are denied in Missouri?

11.7%, insurers in Missouri denied 1,592,551 of 13,603,345 in-network claims across 6 reporting insurers, in the plan-year 2027 release of the CMS Transparency in Coverage Public Use File. The national rate in the plan-year 2027 release is 15.7%.

##### Does Missouri run its own external review, or does the federal process apply?

Missouri runs its own external review process meeting the federal standards, so an independent review there is handled through the state program rather than the federal one. Source: the CCIIO state external review table, linked above and read August 3, 2026. One exception matters more than the rest: This route is the one for insured plans, Marketplace, individual, and employer plans where an insurance company carries the risk. If your coverage is through a job and the employer pays the claims itself (a self-funded or self-insured plan, which is 63% of covered workers), the state process does not apply to you whatever your state operates, and your external review goes through the federal process instead. Your denial letter names your route; if it does not, ask your plan in writing whether the plan is self-funded.

##### My plan is through my job, does this state route apply to me?

Only if an insurance company carries the risk. If your employer pays the claims itself, a self-funded or self-insured plan, which is 63% of covered workers, your plan is not insurance and is outside state insurance regulation, so Missouri's process does not apply to you and your external review goes through the federal process instead. Filing with the state insurance department in that situation is one of the most common ways the external-review stage is lost without ever being heard. Three free ways to check which you have: your ID card and plan documents (self-funded plans usually name the insurer as "administrator" or "third-party administrator"), the Summary Plan Description your employer must give you on request, and your employer's Form 5500 at efast.dol.gov. Your denial letter names your actual route and is the authority.

##### How much does external review cost in Missouri?

Nothing under the HHS-administered federal process. Where an insurer uses a contracted independent review organization or a state process, a filing fee may apply but it cannot exceed $25 per review. The internal appeal is free in every case. Anyone asking you for more than that cap to file an external review is not describing the federal scheme.

##### How many people in Missouri reached independent external review, and how many won?

12 external reviews were filed against 1,592,551 denials in Missouri in the reported year, and 0% of those were overturned. Nationally, 22.2% (1,092 of 4,918; interval 22.2-23.8% for counts CMS withheld; 32.6% without SelectHealth) of external reviews are overturned and the decision is binding on the plan.

##### Which insurer in Missouri denies the most?

By rate, Blue Cross and Blue Shield of Kansas City at 24.5% of in-network claims (26,133 denied). 6 insurers in Missouri report a denial rate; the lowest is Healthy Alliance Life Insurance Company at 7.3%. A denial rate describes the insurer's book of business, not the merits of an individual claim.

##### How long do I have to appeal a denial in Missouri?

Appeal deadlines are federal, not state: generally 180 days from the denial notice for the internal appeal, then generally four months from the final internal denial to request external review. Expedited review is decided in about 72 hours where delay would seriously jeopardize your health. Your denial letter states the deadlines that govern your plan.

Missouri runs 6 insurers with reported rates and they are not close to each other, that is the bit of this page we would not skip. The deadlines are federal, so they are the same wherever you live. What changes by state is who runs the independent review at the end, and getting that wrong is one of the most common ways people lose the last stage without ever being heard. That is why the route for this state is near the top of this page rather than in a footnote. If your plan is through a job, read the self-funded note carefully; it decides which door your review goes through.

Axion Labs · hello@getaxionlabs.com

[Write my appeal letter, free](/appeal-letter)

The [Appeal Kit](/appeal-kit) is the clock, yours and your plan’s, dated from your letter: $29 once.

Where these numbers come from The Missouri figures on this page, 11.7%, 1,592,551 denials and 12 external reviews across 6 insurers, are the state’s own rows in the plan-year 2027 release, issued October 22, 2026. From the plan-year 2024 release to the plan-year 2026 release, external reviews filed went from 2,336 to 5,881. Overturned reviews went from 32.8% in the plan-year 2026 release to 22.2% in plan-year 2027, or from 32.6% to 32.6% without SelectHealth. We do not compare filed or overturned counts across plan-years 2026 and 2027. Some issuers may have counted pre-service appeals in their 2026 cells. The external-review route above comes from [the CCIIO state external review table](https://www.cms.gov/CCIIO/Resources/Files/external_appeals) , read August 3, 2026.

Counts: [CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 claims), data.healthcare.gov — US Government public domain](https://data.healthcare.gov/) . Rights and timeframes: [29 CFR 2560.503-1](https://www.ecfr.gov/current/title-29/section-2560.503-1) (180 days, and your free right to the claim file) and [45 CFR 147.136](https://www.ecfr.gov/current/title-45/section-147.136) (4 months, and what qualifies), explained at [HealthCare.gov](https://www.healthcare.gov/appeal-insurance-company-decision/external-review/) . Expedited review is decided in about 72 hours under both sections.

Reading either regulation from a script rather than a browser: eCFR answers automated fetches with a challenge page, so the same two sections are mirrored as government PDFs at [govinfo.gov (29 CFR 2560.503-1)](https://www.govinfo.gov/content/pkg/CFR-2024-title29-vol9/pdf/CFR-2024-title29-vol9-sec2560-503-1.pdf) and [govinfo.gov (45 CFR 147.136)](https://www.govinfo.gov/content/pkg/CFR-2024-title45-vol2/pdf/CFR-2024-title45-vol2-sec147-136.pdf) .

This page presents federal statistics and a general description of appeal rights created by federal law. It is not legal, medical, or insurance advice, and no outcome is guaranteed. Your denial letter and plan documents govern your specific case. Free help is available from your state's Consumer Assistance Program and from the federal Marketplace at HealthCare.gov.

## The pages that answer the next question

- [Montana: who to call, and the route](/states/montana) , 12.7% of in-network claims denied there, 323,019 of them, and the state-run external-review route.

- [Nebraska: who to call, and the route](/states/nebraska) , 16.6% of in-network claims denied there, 325,332 of them, and the state-run external-review route.

- [New Hampshire: who to call, and the route](/states/new-hampshire) , 8% of in-network claims denied there, 158,490 of them, and the state-run external-review route.

- [If your employer pays the claims itself](/self-funded-denial) , then the company that denied you in Missouri is only administering the plan, your state's external review has no power over the denial, and the route is federal. It is the first question our own calculator asks.

- [If it was refused before the treatment](/prior-authorization-denied) , a prior-authorization refusal from your insurer in Missouri runs on the same two federal clocks as a denied claim, and it can be appealed while the treatment is still ahead of you.

- [Denial code CO-50 on the remittance](/denial-codes/co-50) , "not deemed a medical necessity" is the single most common category in the federal file, and it is the one your insurer in Missouri has to show you the written criteria for.

- [Before you pay a lawyer](/before-you-call-a-lawyer) , two free appeals run before anyone bills you by the hour, and your insurer in Missouri has to hand you the claim file for nothing under 29 CFR 2560.503-1.

- [Where external review is least used](/external-review-gap) , Missouri against every other state on the one stage the insurer does not decide.

- [All states](/states) , the same two columns for every state in the file, Missouri included.

## The two federal clocks

The clock your letter has to describe, in actual dates Whatever else is on the page, these two dates are the page. You have 180 days from the date on your denial notice to file the internal appeal, and then 4 months from the final internal denial to ask for an independent external review. If waiting would seriously jeopardize your health you can ask for both to be expedited, decided in about 72 hours . Both timeframes are federal, not your insurer's choice, 29 CFR 2560.503-1 ( PDF ) and 45 CFR 147.136 ( PDF ), in plain English at HealthCare.gov , and your own denial letter states the ones that govern your plan. The PDFs are the same sections on govinfo.gov, which serves them without a challenge page, so an automated reader can check these two dates as easily as you can.

## How rare the second appeal is

You are not alone, measured rather than said: 83,907,852 in-network claims were denied in a single plan year, and only 4,918 of them, one in 17,061, ever reached the independent review stage. Of the ones that did, 22.2% (1,092 of 4,918; interval 22.2-23.8% for counts CMS withheld; 32.6% without SelectHealth) were overturned.

## What is free here, and what the one paid thing costs

Denied a claim? Insurers upheld 165,863 of the 262,982 internal appeals counted in 2024, 63.1% ( KFF ). The win is at independent external review, and the only way to arrive there is to run the internal stage on time, in the right order, with the record intact. That sequence is what the Appeal Kit is. Get my Appeal Kit, $29 One payment. No subscription. No cut of your claim. Opens on screen the moment you pay. 14-day refund, no questions, one email to hello@getaxionlabs.com. Get my Appeal Kit, $29 Everything you need for your appeal: your two deadlines, the argument that fits your denial reason, the letters, a brief for your doctor on what the reviewer checks, and the external review request. One payment. No subscription. No cut of your claim. Opens on screen the moment you pay. 14-day refund, no questions, one email to hello@getaxionlabs.com.

## What we will not pretend

What we will not pretend. We cannot overturn your denial. Only your plan, or an independent reviewer, can do that. We cannot make your plan cover a service it genuinely excludes. We cannot guarantee external review applies to your denial. It covers medical judgment, experimental or investigational determinations, and rescission, a purely administrative denial may not qualify, and we say so on those pages rather than selling you past it. We have no customer testimonials and publish none. Our evidence is the federal dataset and the regulation cites, both of which you can check.

## Every page on this site

Home Start here Insurers By company States Denial reasons Use cases How to appeal Ranked by denial rate The external-review gap Write the letter, free Deadline calculator Self-funded plan? Prior authorization denied Medicare WISeR denial Denial code CO-50 Before you call a lawyer Attorney for a denied claim Your denial letter United Healthcare denying claims Time limits on a claim Appeal a Medicare denial About Editorial policy How we compare Privacy Terms For machines: llms.txt openapi.json changes.json the composed answer this page as markdown

## Which release these figures are

Which release these figures are Every number on this page is the plan-year 2027 Transparency in Coverage file, issued October 22, 2026, covering plan-year 2025 claims. This is the newest plan year CMS has published: there is no Transparency in Coverage file for a plan year after 2027. The dataset list is at data.healthcare.gov . A test in this site’s build fetches that list on every run and fails if CMS publishes a plan year we have not acknowledged here. Every earlier release, plan-year 2024, plan-year 2025, plan-year 2026, is kept alongside it so the record is visible rather than a single year’s snapshot; /about says what changed between them.

## Where these numbers come from

Where these numbers come from Counts: CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 claims), data.healthcare.gov — US Government public domain . Rights and timeframes: 29 CFR 2560.503-1 (180 days, and your free right to the claim file) and 45 CFR 147.136 (4 months, and what qualifies), explained at HealthCare.gov . Expedited review is decided in about 72 hours under both sections. Reading either regulation from a script rather than a browser: eCFR answers automated fetches with a challenge page, so the same two sections are mirrored as government PDFs at govinfo.gov (29 CFR 2560.503-1) and govinfo.gov (45 CFR 147.136) .

## Who publishes this

Denial Facts publishes federal data about health insurance claim denials. We are independent: not affiliated with, endorsed by, or acting for any insurer, government agency, or review organization. We are not a law firm, a medical provider, or an insurance producer, and nothing here is legal, medical, or insurance advice. Data: CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 claims), data.healthcare.gov — US Government public domain. Figures cover individual-market Qualified Health Plans on the federal Exchange and come from the plan-year 2027 release, issued October 22, 2026, covering plan-year 2025 claims. This is the newest plan year CMS has published: there is no Transparency in Coverage file for a plan year after 2027. See where the data comes from .

## Sources

- CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 claims), data.healthcare.gov — US Government public domain: https://data.healthcare.gov/
- CCIIO state external review table (read August 3, 2026): https://www.cms.gov/CCIIO/Resources/Files/external_appeals
- 29 CFR 2560.503-1 (180 days, and your free right to the claim file): https://www.ecfr.gov/current/title-29/section-2560.503-1
- 45 CFR 147.136 (4 months, and what qualifies): https://www.ecfr.gov/current/title-45/section-147.136
- HealthCare.gov on external review: https://www.healthcare.gov/appeal-insurance-company-decision/external-review/

Cite: Axion Labs — Denial Facts, "Missouri: who to call about a denied health claim", https://denialfacts.com/states/missouri (checked 2026-11-04). free to quote with the URL.