What is the average health insurance denial rate in North Dakota?

Health insurers in North Dakota deny approximately 17.1% of ACA marketplace claims, which is 2.0 points below the national average of 19.1%.

How do I appeal a denied insurance claim in North Dakota?

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 North Dakota Insurance Department. IMRs are free, decided by independent clinicians, and have high success rates.

Which insurance company denies the most claims in North Dakota?

Based on CMS Marketplace Transparency data, the insurers with the highest denial rates in North Dakota 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 North Dakota?

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

North Dakota Insurance Denial Report

The worst health insurers in North Dakota
by claim denial rate

North Dakota averages a 17.1% denial rate — 2.0 points below the national average. About 38,000 claims are denied annually.

Fight My Denial in North Dakota →

17.1%

North Dakota avg denial rate

19.1%

National average

38,000

Annual denials in state

>80%

Appeals overturned when filed

Health insurance denials in North Dakota

In North Dakota, the average health insurance claim denial rate stands at 17.1%, which is slightly below the national average of 19.1%. This statistic translates to approximately 38,000 claims denied annually, affecting countless individuals and families seeking necessary medical care. Understanding this denial rate is crucial for patients, as it highlights the importance of being proactive in managing their health insurance claims. While a denial can be disheartening, it is essential to recognize that it is not the end of the road. Patients have options and rights that empower them to challenge these decisions effectively.

Patients in North Dakota have the right to appeal any denied claims. If an internal appeal does not yield the desired outcome, individuals can escalate their case to the North Dakota Insurance Department, the state’s regulatory body overseeing insurance practices. This department provides resources and guidance to help patients navigate the appeals process. By understanding their rights and the available channels for recourse, patients can advocate for themselves and work towards obtaining the coverage they deserve.

Worst insurers in North Dakota 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 North Dakota insurance patient

In North Dakota, patients are protected by specific rights 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 resolve the issue, patients can request an external Independent Medical Review, which provides an unbiased evaluation of the claim. The North Dakota Insurance Department oversees these processes, ensuring that patients are treated fairly. Additionally, filing a complaint with this regulatory body is free of charge and can serve as a powerful tool to pressure insurers to reconsider their decisions.

North Dakota Insurance Department
https://www.insurance.nd.gov

Start My North Dakota Appeal →

How to appeal a denial in North Dakota

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 North Dakota 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 North Dakota Insurance Department. 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 North Dakotaby claim denial rate