What is the average health insurance denial rate in Montana?

Health insurers in Montana deny approximately 18.5% of ACA marketplace claims, which is 0.6 points below the national average of 19.1%.

How do I appeal a denied insurance claim in Montana?

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 Montana Commissioner of Securities & Insurance. IMRs are free, decided by independent clinicians, and have high success rates.

Which insurance company denies the most claims in Montana?

Based on CMS Marketplace Transparency data, the insurers with the highest denial rates in Montana are UnitedHealthcare, Ambetter from Centene. See each insurer's full denial report for category-level breakdowns.

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

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

Montana Insurance Denial Report

The worst health insurers in Montana
by claim denial rate

Montana averages a 18.5% denial rate — 0.6 points below the national average. About 55,000 claims are denied annually.

Fight My Denial in Montana →

18.5%

Montana avg denial rate

19.1%

National average

55,000

Annual denials in state

>80%

Appeals overturned when filed

Health insurance denials in Montana

In Montana, health insurance claim denials are a significant concern, with an average denial rate of 18.5% in 2023. This figure is slightly below the national average of 19.1%, indicating that while Montana's rate is relatively favorable, it still translates to approximately 55,000 annual denials. For many residents, this means facing unexpected challenges in accessing necessary healthcare services and treatments. Understanding the implications of these denial rates is crucial for Montanans who rely on health insurance to safeguard their well-being.

Fortunately, patients in Montana have the right to appeal denied claims, empowering them to advocate for their healthcare needs. If a claim is denied, individuals can initiate an internal appeal with their insurer, and if that does not yield a satisfactory outcome, they can escalate the matter to the Montana Commissioner of Securities & Insurance. This regulatory body oversees health insurance practices in the state and provides an avenue for patients to ensure their rights are upheld, fostering a more equitable healthcare environment for all Montanans.

Worst insurers in Montana by denial rate

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

UnitedHealthcare

32.5% denial rate

UHC denies 32.5% of claims — 13.4 points above the national average. Their appeal overturn rate is 57%.

Specialty Medications: 43% deniedGLP-1 Medications: 41% deniedMRI / CT Scans: 35% denied

Full UHC 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 →

Your rights as a Montana insurance patient

Montana offers specific patient protections that empower individuals facing claim denials. Patients have the right to an internal appeal process, allowing them to contest denied claims directly with their insurance provider. Additionally, Montana residents can request an external Independent Medical Review if their internal appeal is unsuccessful. The Montana Commissioner of Securities & Insurance oversees these processes, ensuring that patients can file complaints at no cost. This not only helps to pressure insurers to reconsider their decisions but also reinforces the rights of patients to receive fair treatment in their healthcare journeys.

Montana Commissioner of Securities & Insurance
https://csimt.gov

Start My Montana Appeal →

How to appeal a denial in Montana

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 Montana 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 Montana Commissioner of Securities & 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 →

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The worst health insurers in Montanaby claim denial rate