Health insurance claim denials in Texas
Insurers in Texas denied 7,150,996 in-network claims — 16.9% of everything submitted. Just 961 reached independent external review, and 77.6% of those were overturned.
Texas — in-network denial rate
16.9%
7,150,996 of 42,332,556 claims · 15 insurers reporting
Your rights in Texas 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 Texas
Federal process
CMS lists Texas among the states without an external review process meeting the federal standards. Insurers there must use either the HHS-administered federal process or an independent review organisation they contract with. Source: CCIIO state external review table, checked 3 August 2026.
Notice for Texas, current as of 3 August 2026. CMS states that the HHS-Administered Federal External Review Process has been temporarily unavailable since 1 July 2026 for people whose plan uses that process, and that HHS will provide information about extending deadlines. This does not remove your right to external review. Follow the instructions in your own denial notice, keep dated evidence of every attempt to file, and check the CCIIO page for the current position before you rely on this. If your plan uses a contracted independent review organisation rather than the federal process, this does not affect you.
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 Texas
| Insurer | Denial rate | Denied | External reviews |
|---|---|---|---|
| Aetna Health Inc. (a TX corp.) | 34.1% | 98,052 | — |
| UnitedHealthcare of Texas, Inc. | 30.1% | 615,246 | 15 |
| Sendero Health Plans, Inc. | 29.1% | 83,908 | — |
| Moda Health Plan, Inc. | 25.7% | 4,377 | — |
| Blue Cross Blue Shield of Texas | 19.6% | 2,666,196 | 69 |
| Superior Health Plan | 18.2% | 407,805 | 85 |
| Molina Healthcare of Texas, Inc. | 17.4% | 83,574 | 70 |
| Community Health Choice, Inc. | 15% | 586,369 | 16 |
| Celtic Insurance Company | 14.1% | 1,763,710 | 660 |
| Scott and White Health Plan | 13.4% | 325,281 | 13 |
| Oscar Insurance Company | 11.7% | 498,535 | 33 |
| CHRISTUS Health Plan | 6.9% | 17,943 | — |
| Cigna HealthCare of Texas, Inc. | — | — | — |
| Imperial Insurance Companies, Inc. | — | — | — |
| US HEALTH AND LIFE INSURANCE COMPANY | — | — | — |
Everything you need for your appeal in Texas: 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.