CHRISTUS Health Plan Louisiana (Louisiana) in-network claim denial rate: 17.3%

In the CMS Transparency in Coverage file for plan year 2025, CHRISTUS Health Plan Louisiana reported denying 14,107 of 81,774 in-network claims (17.3%) in Louisiana, from 2023 claims. 10.4% of internal appeals were overturned (27 of 260). That is the 2nd highest reported rate of 4 ranked issuers in Louisiana; the state median is 16.9%.

Denial rate

17.3%

14,107 of 81,774 claims

Appeals overturned

10.4%

27 of 260 filed

External review overturned

0.0%

0 of 0 filed

Prior file (plan year 2024, 2022 claims): denial rate 7.8% (1,615 of 20,583); appeal overturn rate 34.7%.

Compared with Louisiana and the national median

Measure	CHRISTUS Health Plan Louisiana	Louisiana median	National median
In-network denial rate	17.3%	16.9%	18.3%
In-network claims received	81,774	—	—
Internal appeals filed	260	—	—
Internal appeal overturn rate	10.4%	28.8%	41.7%
External reviews filed	0	—	—
External review overturn rate	0.0%	15.9%	0.0%
Out-of-network denial rate	53.7%	—	—

Medians are across issuers with at least 1,000 in-network claims received in the same file (Louisiana: 4 issuers; national: 176 issuers in 32 states). Plan year 2025 file, 2023 claims.

Read these numbers carefully

Reporting lag: the CMS public-use file for a plan year reports claims from two plan years earlier (the PY2025 file carries 2023 claims). These are not this year's figures.
In-network only: the denial rate is in-network claims denied divided by in-network claims received. Out-of-network claims are shown separately where the issuer reported them.
"Denied" is broad: CMS counts every denial, including administrative denials, duplicate submissions, ineligibility, incorrect billing and partial denials, not only medical-necessity decisions.
Issuer level: CMS reports the counts once per issuer per state and repeats them on every plan row; plan-level counts, where present, list denials only, so no per-plan rate is computed.
Coverage: only issuers on the federally facilitated marketplace (HealthCare.gov states) report to this file. Employer plans, Medicare and Medicaid are not included.
No inference of intent: a higher rate can reflect the issuer's mix of claims, its billing rules or its membership as much as its coverage decisions. Compare with the state median and read the N.

Source: CMS Transparency in Coverage Public Use File (Health Insurance Exchange PUFs), plan year 2025; data dictionary. Issuer's own claims-payment policy page: https://www.christushealthplan.org/member-resources/coverage/individual-family-plans/transparency-in-coverage.

If CHRISTUS Health Plan Louisiana denied your claim

A denial is a decision you can contest. Marketplace plans must give you at least 180 days to file an internal appeal and offer independent external review after it (45 CFR 147.136). The letter states your deadline.

Plans in this filing (45)

Where CMS lists plan-level denial counts they are shown; no plan-level rate is computed because the file does not give plan-level claims received.

Plan ID	Type	Metal	Plan-level denials (in-network)
98780LA0010001	HMO	Silver	843
98780LA0010002	HMO	Silver	792
98780LA0010003	HMO	Silver	1,021
98780LA0030001	HMO	Gold	88
98780LA0030002	HMO	Gold	35
98780LA0030003	HMO	Gold	16
98780LA0040001	HMO	Bronze	616
98780LA0040002	HMO	Bronze	767
98780LA0040003	HMO	Bronze	781
98780LA0080001	HMO	Silver	219
98780LA0080002	HMO	Silver	205
98780LA0080003	HMO	Silver	370
98780LA0090001	HMO	Gold	11
98780LA0090002	HMO	Gold	18
98780LA0090003	HMO	Gold	n/a
98780LA0120001	HMO	Silver	2,518
98780LA0120002	HMO	Silver	1,662
98780LA0120003	HMO	Silver	2,197
98780LA0130001	HMO	Gold	n/a
98780LA0130002	HMO	Gold	0
98780LA0130003	HMO	Gold	n/a
98780LA0140001	HMO	Bronze	n/a
98780LA0140002	HMO	Bronze	n/a
98780LA0140003	HMO	Bronze	n/a
98780LA0150001	HMO	Bronze	n/a
98780LA0150002	HMO	Bronze	n/a
98780LA0150003	HMO	Bronze	n/a
98780LA0160001	HMO	Bronze	n/a
98780LA0160002	HMO	Bronze	n/a
98780LA0160003	HMO	Bronze	n/a
98780LA0170001	HMO	Bronze	n/a
98780LA0170002	HMO	Bronze	n/a
98780LA0170003	HMO	Bronze	n/a
98780LA0180001	HMO	Silver	n/a
98780LA0180002	HMO	Silver	n/a
98780LA0180003	HMO	Silver	n/a
98780LA0190001	HMO	Silver	n/a
98780LA0190002	HMO	Silver	n/a
98780LA0190003	HMO	Silver	n/a
98780LA0200001	HMO	Gold	n/a
98780LA0200002	HMO	Gold	n/a
98780LA0200003	HMO	Gold	n/a
98780LA0210001	HMO	Gold	n/a
98780LA0210002	HMO	Gold	n/a
98780LA0210003	HMO	Gold	n/a

Questions

What counts as a "denied" claim in CHRISTUS Health Plan Louisiana's 17.3% rate?

Every in-network claim the issuer reported as denied in the 2023 claims year, including administrative denials, duplicates, ineligibility, incorrect billing and partial denials, not only medical-necessity decisions. The figure is in-network claims denied divided by in-network claims received, exactly as reported to CMS.

Why is the data from 2023 when the file is for plan year 2025?

CMS's Transparency in Coverage public use file for a plan year reports claims data from two plan years earlier. This is the most recent issuer-level denial data CMS publishes for marketplace plans.

Does this predict whether my CHRISTUS Health Plan Louisiana claim will be denied?

No. It is an aggregate across all of the issuer's marketplace plans in Louisiana. Your own claim depends on your plan, the service and the documentation. Compare the rate with the Louisiana median (16.9%) and read the N before drawing conclusions.

How do I appeal a CHRISTUS Health Plan Louisiana denial?

Read the denial letter for the reason and the deadline, request the criteria and the claim file in writing, and file an internal appeal (at least 180 days on marketplace plans under 45 CFR 147.136). In the reporting year, 10.4% of internal appeals to this issuer were overturned (27 of 260). If the internal appeal fails, independent external review is available.

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Cite: Apellica Insurer Denial Report Cards, CHRISTUS Health Plan Louisiana (Louisiana), plan year 2025, from the CMS Transparency in Coverage PUF. CC BY 4.0. Download the full table as CSV or read the methodology. Corrections: editorial@apellica.com.