What is the average health insurance denial rate in Indiana?

Health insurers in Indiana deny approximately 20.4% of ACA marketplace claims, which is 1.3 points above the national average of 19.1%.

How do I appeal a denied insurance claim in Indiana?

File a written internal appeal with your insurer within 180 days of the denial. If denied again, escalate to an Independent Medical Review (IMR) with the Indiana Department of Insurance. IMRs are free, decided by independent clinicians, and have high success rates.

Which insurance company denies the most claims in Indiana?

Based on CMS Marketplace Transparency data, the insurers with the highest denial rates in Indiana are Oscar Health, Ambetter from Centene, Anthem Blue Cross Blue Shield. See each insurer's full denial report for category-level breakdowns.

What are my rights if my insurance claim is denied in Indiana?

You have the right to a full written explanation of the denial, an internal appeal, and an external Independent Medical Review with the Indiana Department of Insurance. Federal law requires insurers to respond to standard appeals within 30 days and urgent appeals within 72 hours.

Indiana Insurance Denial Report

The worst health insurers in Indiana
by claim denial rate

Indiana averages a 20.4% denial rate — 1.3 points above the national average. About 310,000 claims are denied annually.

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20.4%

Indiana avg denial rate

19.1%

National average

310,000

Annual denials in state

>80%

Appeals overturned when filed

Health insurance denials in Indiana

In Indiana, the average health insurance claim denial rate stands at 20.4%, surpassing the national average of 19.1%. This statistic translates to approximately 310,000 annual claim denials, impacting countless individuals and families across the state. Such a high denial rate highlights the challenges many Hoosiers face when seeking necessary medical care and the importance of understanding their rights in navigating the insurance landscape. Each denial represents not just a statistic, but a real-life barrier to accessing essential health services, underscoring the need for awareness and action among patients.

Fortunately, patients in Indiana have the right to appeal denied claims, empowering them to challenge these decisions. The Indiana Department of Insurance serves as the regulatory body overseeing health insurance practices in the state. This agency provides resources and guidance for individuals who wish to escalate their cases when faced with unjust denials. By exercising their rights to appeal, patients can advocate for themselves and ensure that their voices are heard in the insurance process, working towards a resolution that supports their health needs.

Worst insurers in Indiana by denial rate

Source: CMS Marketplace Transparency Report 2023. In-network ACA marketplace claims only.

Oscar Health

34.6% denial rate

Oscar denies 34.6% of claims — 15.5 points above the national average. Their appeal overturn rate is 58%.

GLP-1 Medications: 46% deniedMental Health: 41% deniedSpecialty Medications: 38% denied

Full Oscar denial report →

Ambetter from Centene

21.3% denial rate

Ambetter denies 21.3% of claims — 2.2 points above the national average. Their appeal overturn rate is 53%.

GLP-1 Medications: 36% deniedSpecialty Medications: 28% deniedMental Health: 24% denied

Full Ambetter denial report →

Anthem Blue Cross Blue Shield

18.8% denial rate

Anthem denies 18.8% of claims — 0.3 points below the national average. Their appeal overturn rate is 63%.

GLP-1 Medications: 32% deniedSpecialty Medications: 25% deniedMental Health: 20% denied

Full Anthem denial report →

Your rights as a Indiana insurance patient

In Indiana, patients are afforded specific protections when it comes to health insurance claims. They have the right to an internal appeal, allowing them to contest a denial directly with their insurer. If the internal appeal does not yield a satisfactory outcome, patients can request an external Independent Medical Review, providing an unbiased assessment of the claim. The Indiana Department of Insurance is available to assist individuals in understanding these rights, and filing a complaint with the department is a free process that can pressure insurers to reconsider their decisions.

Indiana Department of Insurance
https://www.in.gov/idoi

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How to appeal a denial in Indiana

1
Request the denial in writing
Ask your insurer for the specific clinical criteria and coverage policy they used to deny you. They are legally required to provide it within 30 days.
2
File your internal appeal
Send a written appeal to your insurer within 180 days. Cite your doctor's clinical documentation, relevant medical guidelines, and Indiana insurance law. A well-written appeal citing specific laws wins over 80% of the time.
3
Escalate to the state if denied again
If your internal appeal is denied, file an Independent Medical Review (IMR) with the Indiana Department of Insurance. This is free and decided by independent clinicians. Their decision is often binding.
4
Use disputes.health to generate your letter
Our agents generate a clinic-grade appeal letter in under 15 minutes — citing your state's laws, relevant medical guidelines, and your specific situation. We then submit it to your insurer for you.

How to appeal a denial →GLP-1 denial guide →Mental health denial guide →All public resources →

Denied in Indiana? Fight back today.

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The worst health insurers in Indianaby claim denial rate