Health insurance claim denials in North Carolina
Insurers in North Carolina denied 4,279,513 in-network claims — 19.4% of everything submitted. Just 47 reached independent external review, and 53.2% of those were overturned.
North Carolina — in-network denial rate
19.4%
4,279,513 of 22,018,737 claims · 9 insurers reporting
Your rights in North Carolina are federal. Every non-grandfathered plan must give you an internal appeal, and an independent external review for denials involving medical judgement, 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 North Carolina
State-run process
CMS lists North Carolina as running its own external review process that meets the federal standards, so your independent review is handled through the state programme rather than the federal one. Source: CCIIO state external review table, checked 3 August 2026.
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 organisation or a state process, a filing fee may apply, but it cannot exceed $25.
Insurers in North Carolina
| Insurer | Denial rate | Denied | External reviews |
|---|---|---|---|
| Celtic Insurance Company | 41.8% | 1,193 | — |
| AmeriHealth Caritas North Carolina, Inc. | 37.9% | 310 | — |
| UnitedHealthcare of North Carolina, Inc | 29.9% | 491,960 | — |
| Blue Cross and Blue Shield of NC | 18.9% | 3,337,685 | 47 |
| Ambetter of North Carolina Inc. | 17% | 190,418 | — |
| Aetna Health Inc. (a PA corp.) | 16.8% | 134,490 | — |
| Cigna HealthCare of North Carolina, Inc. | 16.3% | 121,708 | — |
| Oscar Health Plan of North Carolina, Inc | 15.8% | 1,749 | — |
| CareSource North Carolina Co. | — | — | — |
Everything you need for your appeal in North Carolina: 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.
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.