Oregon Insurance Denial Report

The worst health insurers in Oregon
by claim denial rate

Oregon averages a 16.2% denial rate — 2.9 points below the national average. About 185,000 claims are denied annually.

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16.2%
Oregon avg denial rate
19.1%
National average
185,000
Annual denials in state
>80%
Appeals overturned when filed

Health insurance denials in Oregon

In Oregon, the average health insurance claim denial rate stands at 16.2%, which is notably lower than the national average of 19.1%. This statistic translates to approximately 185,000 annual claim denials affecting residents across the state. While this figure is encouraging, it still represents a significant number of individuals facing challenges in accessing the healthcare services they need. Understanding the denial rate is crucial for Oregonians, as it highlights the importance of being informed and proactive when dealing with health insurance claims.

Worst insurers in Oregon by denial rate

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

1

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 →
2

Kaiser Permanente

12.4% denial rate

Kaiser denies 12.4% of claims — 6.7 points below the national average. Their appeal overturn rate is 70%.

GLP-1 Medications: 19% deniedSpecialty Medications: 15% deniedMental Health: 12% denied
Full Kaiser denial report →

Your rights as a Oregon insurance patient

In Oregon, patients are empowered by specific protections regarding health insurance claims. They have the right to an internal appeal if their claim is denied, allowing them to contest the decision within their insurance company. Additionally, patients can seek an external Independent Medical Review for further evaluation of their case. The Oregon Insurance Division serves as the regulatory body overseeing these processes, ensuring that patients can file complaints free of charge. This can create pressure on insurers to reconsider their decisions, ultimately supporting patients in their pursuit of necessary healthcare.

Oregon Insurance Division
https://dfr.oregon.gov/insure

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How to appeal a denial in Oregon

  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 Oregon 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 Oregon Insurance Division. 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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