Rhode Island Insurance Denial Report

The worst health insurers in Rhode Island
by claim denial rate

Rhode Island averages a 13.7% denial rate — 5.4 points below the national average. About 48,000 claims are denied annually.

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13.7%
Rhode Island avg denial rate
19.1%
National average
48,000
Annual denials in state
>80%
Appeals overturned when filed

Health insurance denials in Rhode Island

In Rhode Island, the average health insurance claim denial rate stands at 13.7%, which is notably lower than the national average of 19.1%. This statistic translates to approximately 48,000 denials annually, highlighting a significant issue that affects many residents. While Rhode Island's denial rate is more favorable, it still represents a considerable number of individuals facing challenges when seeking coverage for necessary medical services. Understanding this landscape is crucial for patients as they navigate their healthcare options and insurance claims.

Worst insurers in Rhode Island by denial rate

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

1

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 →
2

Aetna (CVS Health)

17.2% denial rate

Aetna denies 17.2% of claims — 1.9 points below the national average. Their appeal overturn rate is 65%.

GLP-1 Medications: 28% deniedSpecialty Medications: 22% deniedMental Health: 18% denied
Full Aetna denial report →

Your rights as a Rhode Island insurance patient

Rhode Island offers specific patient protections that empower individuals facing claim denials. Patients have the right to an internal appeal process, allowing them to contest denials directly with their insurance provider. If the internal appeal is unsuccessful, they can request an external Independent Medical Review, providing an unbiased evaluation of their case. The Rhode Island Department of Business Regulation oversees these processes, ensuring that patients can file complaints at no cost. This can create pressure on insurers to reconsider their decisions, reinforcing the importance of advocating for one's healthcare rights.

Rhode Island Department of Business Regulation
https://dbr.ri.gov/insurance

Start My Rhode Island Appeal →

How to appeal a denial in Rhode Island

  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 Rhode Island 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 Rhode Island Department of Business Regulation. 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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