Texas Department of Insurance complaint, the number to call first, then the date that is running
Put in the date on your notice and get both federal deadlines as calendar dates.
Free, for a denial in Texas, 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 Texas or to the federal process, the part that is not the same in every state.
The Texas consumer service is open 8 a.m. to 5 p.m. Central time, Monday - Friday, and it 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.
Read from www.tdi.texas.gov on September 9, 2026. If the number has changed, tell us and we will fix it the same day.Insurers in Texas denied 22,372,063 in-network claims in this release, 18.5% of everything submitted.
Insurance company denied claim. What do we do?
Those are the plan-year 2026 release figures, from the federal Transparency in Coverage file issued September 26, 2025. Just 1,908 of those Texas denials reached independent external review, and 44.5% of those were overturned.
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 (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.
You are not alone in this, and it can be measured: insurers in Texas denied 22,372,063 in-network claims in a single plan year across 18 reporting insurers. Of those denials, 1,908 reached the one stage whose decision the insurer has to obey.
- Among the 30 states in the federal file, Texas has the 14th highest denial rate at 18.5%, against a national 18.7%.
- Which insurer you happen to be with matters more here than the state average does: inside Texas the reported rates run from 35.7% (Imperial Insurance Companies, Inc.) down to 11.7% (CHRISTUS Health Plan).
- For every 10,000 claims denied in Texas, about 40 came back as an internal appeal.
- Of 22,372,063 denials, 1,908 reached independent external review, about 85.3 for every million denied claims.
- The reason recorded most often in Texas is other reasons, 38.7% of its categorized denials against 32.3% nationally.
- Find the reason code on your denial letter. Whichever of the 18 insurers reporting in Texas 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 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. 1,908 external reviews were filed in Texas against 22,372,063 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.
What that Texas external-review count means for your own denial, and by when. 1,908 independent external reviews were filed in Texas against 22,372,063 denials, and 44.5% of them were overturned, Texas's own rows in the plan-year 2026 release of the CMS Transparency in Coverage file, read September 5, 2026 (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), carried onto individual-market coverage by 45 CFR 147.136(b)(3)(i)), while Medicare Advantage gives you 60 calendar days after you receive its notice (42 CFR 422.582(b)) and Medicaid managed care the same 60 calendar days from the date on the notice (42 CFR 438.402(c)(2)(ii)), both stages free, and the three steps above are the whole of what to do tonight, and the Texas route at the end of them is on this page. Nothing on this page is for sale: the consumer line above, the letter and the deadline calculator are all free, and none of them asks for an email.
Insurers in Texas
| Insurer | Denial rate | Denied | External reviews |
|---|---|---|---|
| Imperial Insurance Companies, Inc. | 35.7% | 902 | 0 |
| Community First Insurance Plans | 30.6% | 34,419 | not reported |
| Oscar Insurance Company | 25.5% | 764,285 | 517 |
| Moda Health Plan, Inc. | 24.3% | 34,484 | not reported |
| Molina Healthcare of Texas, Inc. | 24% | 237,126 | 21 |
| Superior Health Plan | 22.2% | 1,287,305 | 62 |
| Cigna HealthCare of Texas, Inc. | 21.7% | 884,055 | not reported |
| Sendero Health Plans, Inc. | 21.5% | 101,311 | not reported |
| Community Health Choice, Inc. | 21.4% | 1,449,319 | 26 |
| Blue Cross Blue Shield of Texas | 18.8% | 11,028,737 | 808 |
| UnitedHealthcare of Texas, Inc. | 17.4% | 2,550,560 | 67 |
| Celtic Insurance Company | 16.3% | 2,652,607 | 237 |
| Scott and White Health Plan | 14.6% | 1,205,777 | 170 |
| CHRISTUS Health Plan | 11.7% | 141,176 | 0 |
| Community Health Choice Texas, Inc. | not reported | not reported | not reported |
| Harbor Health Insurance Company | not reported | not reported | not reported |
| UnitedHealthcare Benefits of Texas, Inc. | not reported | not reported | not reported |
| Wellpoint Insurance Company | not reported | not reported | not reported |
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Questions about appealing in Texas
What percentage of health insurance claims are denied in Texas?
18.5%, insurers in Texas denied 22,372,063 of 120,606,438 in-network claims across 18 reporting insurers, in the plan-year 2026 release of the CMS Transparency in Coverage Public Use File. The national rate in the plan-year 2026 release is 18.7%.
Does Texas run its own external review, or does the federal process apply?
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 organization they contract with. Note: CMS says that process reopened on July 31, 2026, and that anyone who could not file between July 1, 2026 and August 3, 2026 may have until October 2, 2026 to request external review, and HealthCare.gov adds that the extension may also reach a state or local government plan in any state. Sources: the CCIIO state external review table (route), read August 3, 2026; the CCIIO page and HealthCare.gov on external review (the reopening and the extension), both read September 5, 2026.
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 Texas'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 Texas?
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 Texas reached independent external review, and how many won?
1,908 external reviews were filed against 22,372,063 denials in Texas in the reported year, and 44.5% of those were overturned. Nationally, 32.8% of external reviews are overturned and the decision is binding on the plan.
Which insurer in Texas denies the most?
By rate, Imperial Insurance Companies, Inc. at 35.7% of in-network claims (902 denied). 14 insurers in Texas report a denial rate; the lowest is CHRISTUS Health Plan at 11.7%. 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 Texas?
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.
Texas runs 14 insurers with reported rates and they are not close to each other, that is the bit of this page I 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.
, Andrew at Axion Labs · hello@getaxionlabs.comNothing on this page is for sale. The Texas consumer line above is free, the letter is free, and the deadline calculator is free. If you would rather have every step dated around your denial, the Appeal Kit is on its own page, you do not need it to use anything here.
The Texas figures on this page, 18.5%, 22,372,063 denials and 1,908 external reviews across 18 insurers, are the state’s own rows in the plan-year 2026 release, issued September 26, 2025. Across the three Transparency in Coverage releases CMS has published, external reviews filed rose from 2,336 to 5,881 while the share overturned fell from 44% in the plan-year 2024 release to 32.8% in the plan-year 2026 release. The external-review route above comes from the CCIIO state external review table, read August 3, 2026.
Counts: CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 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).
Questions people ask
These are the questions Google shows people asking alongside this page, in the words they are asked in. Each one gets one sentence, from the same sources as the rest of the page.
How do I file a complaint against an insurance company in Texas?
The Texas Department of Insurance takes consumer complaints on the line and complaint form printed above, and making that call costs nothing and uses up none of your appeal window.
Who do I contact to make a complaint about an insurance company?
In Texas it is the Texas Department of Insurance consumer service shown on this page; where the coverage comes through a job, the US Department of Labor takes the same complaint.
What is the Texas Department of Insurance responsible for?
It regulates the insurers licensed in Texas and runs the independent review route at the end of an appeal, the route 1,908 Texas denials reached in the plan-year 2026 CMS Transparency in Coverage release, of which 849 were overturned.
How can I file a complaint against an insurance company?
A complaint to a state department of insurance is a separate thing from your appeal, and one does not pause the other: file the internal appeal with the insurer inside the 180 days 29 CFR 2560.503-1(h)(3)(i) allows, and file the complaint alongside it.