Idaho Insurance Denial Report

The worst health insurers in Idaho
by claim denial rate

Idaho averages a 19.6% denial rate — 0.5 points above the national average. About 85,000 claims are denied annually.

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19.6%
Idaho avg denial rate
19.1%
National average
85,000
Annual denials in state
>80%
Appeals overturned when filed

Health insurance denials in Idaho

In Idaho, the health insurance claim denial rate stands at 19.6%, slightly above the national average of 19.1%. This statistic translates to approximately 85,000 annual claim denials, highlighting a significant challenge faced by residents seeking necessary medical care. Understanding this denial rate is crucial for patients, as it underscores the importance of being proactive in navigating the complexities of health insurance. Each denial represents not just a statistic but a real-life impact on individuals and families who may struggle to access essential health services.

Worst insurers in Idaho by denial rate

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

1

Molina Healthcare

22.4% denial rate

Molina denies 22.4% of claims — 3.3 points above the national average. Their appeal overturn rate is 55%.

GLP-1 Medications: 38% deniedSpecialty Medications: 30% deniedMental Health: 25% denied
Full Molina denial report →
2

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 Idaho insurance patient

Idaho law provides specific protections for patients facing claim denials. Residents have the right to an internal appeal, allowing them to challenge the insurer’s decision directly. If the internal appeal is unsuccessful, patients can request an external Independent Medical Review to obtain an unbiased assessment of their claim. The Idaho Department of Insurance oversees these processes, ensuring that patients are treated fairly. Additionally, filing a complaint with the Department is free and can create pressure on insurers to reconsider their denial, empowering patients to advocate for their health needs.

Idaho Department of Insurance
https://doi.idaho.gov

Start My Idaho Appeal →

How to appeal a denial in Idaho

  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 Idaho 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 Idaho Department of 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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