Missouri Insurance Denial Report

The worst health insurers in Missouri
by claim denial rate

Missouri averages a 21.2% denial rate — 2.1 points above the national average. About 320,000 claims are denied annually.

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21.2%
Missouri avg denial rate
19.1%
National average
320,000
Annual denials in state
>80%
Appeals overturned when filed

Health insurance denials in Missouri

In Missouri, the average health insurance claim denial rate stands at 21.2%, significantly higher than the national average of 19.1%. This translates to approximately 320,000 denied claims each year, highlighting a pressing issue for many residents who rely on health insurance for their medical needs. These denial rates can create significant barriers to accessing necessary care, leaving patients feeling frustrated and uncertain about their rights and options. Understanding the scope of this problem is crucial for Missourians, as it empowers them to take action when faced with a denial.

Worst insurers in Missouri by denial rate

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

1

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 →
2

Cigna Healthcare

33.1% denial rate

Cigna denies 33.1% of claims — 14.0 points above the national average. Their appeal overturn rate is 61%.

GLP-1 Medications: 44% deniedSpecialty Medications: 40% deniedMental Health: 37% denied
Full Cigna denial report →
3

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 →

Your rights as a Missouri insurance patient

In Missouri, patients are protected with specific rights when it comes to health insurance claim denials. Individuals have the right to an internal appeal, allowing them to contest a denial directly with their insurer. If the internal appeal is unsuccessful, patients can request an external Independent Medical Review, which provides an unbiased evaluation of the claim. The Missouri Department of Commerce & Insurance oversees these processes, ensuring that patients are treated fairly. Filing a complaint with this regulatory body is free and can encourage insurers to reconsider their decisions, empowering patients to advocate for their health and rights.

Missouri Department of Commerce & Insurance
https://insurance.mo.gov

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How to appeal a denial in Missouri

  1. 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. 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 Missouri insurance law. A well-written appeal citing specific laws wins over 80% of the time.
  3. 3
    Escalate to the state if denied again
    If your internal appeal is denied, file an Independent Medical Review (IMR) with the Missouri Department of Commerce & Insurance. This is free and decided by independent clinicians. Their decision is often binding.
  4. 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 →

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