Blue Cross and Blue Shield of Montana (Montana) in-network claim denial rate: 39.5%

In the CMS Transparency in Coverage file for plan year 2025, Blue Cross and Blue Shield of Montana reported denying 93,689 of 237,510 in-network claims (39.5%) in Montana, from 2023 claims. 26.3% of internal appeals were overturned (61 of 232). That is the 1st highest reported rate of 3 ranked issuers in Montana; the state median is 5.7%.

Denial rate

39.5%

93,689 of 237,510 claims

Appeals overturned

26.3%

61 of 232 filed

External review overturned

n/a

not reported

Prior file (plan year 2024, 2022 claims): denial rate 13.6% (122,466 of 902,193); appeal overturn rate 25.3%.

Compared with Montana and the national median

Measure	Blue Cross and Blue Shield of Montana	Montana median	National median
In-network denial rate	39.5%	5.7%	18.3%
In-network claims received	237,510	—	—
Internal appeals filed	232	—	—
Internal appeal overturn rate	26.3%	23.1%	41.7%
External reviews filed	n/a	—	—
External review overturn rate	n/a	0.0%	0.0%
Out-of-network denial rate	27.9%	—	—

Medians are across issuers with at least 1,000 in-network claims received in the same file (Montana: 3 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.bcbsmt.com/insurance-basics/coverage-information/transparency-in-coverage.

If Blue Cross and Blue Shield of Montana 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 (67)

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)
30751MT0550038	PPO	Gold	765
30751MT0550039	PPO	Silver	414
30751MT0550040	PPO	Bronze	912
30751MT0550041	PPO	Bronze	1,165
30751MT0550042	PPO	Catastrophic	n/a
30751MT0550043	PPO	Gold	3,421
30751MT0550044	PPO	Gold	2,219
30751MT0550045	PPO	Gold	2,210
30751MT0550046	PPO	Silver	1,725
30751MT0550047	PPO	Silver	707
30751MT0550048	PPO	Silver	1,646
30751MT0550049	PPO	Bronze	3,957
30751MT0550050	PPO	Bronze	2,178
30751MT0550051	PPO	Bronze	5,735
30751MT0550052	PPO	Bronze	3,224
30751MT0550053	PPO	Bronze	1,139
30751MT0550054	PPO	Bronze	5,742
30751MT0550055	PPO	Catastrophic	49
30751MT0550056	PPO	Catastrophic	n/a
30751MT0550057	PPO	Catastrophic	0
30751MT0550061	PPO	Silver	871
30751MT0550071	PPO	Silver	2,963
30751MT0550072	PPO	Silver	2,076
30751MT0550073	PPO	Silver	5,861
30751MT0550086	PPO	Gold	128
30751MT0550087	PPO	Silver	84
30751MT0550089	PPO	Gold	596
30751MT0550090	PPO	Silver	401
30751MT0550092	PPO	Bronze	63
30751MT0550093	PPO	Bronze	571
30751MT0550094	PPO	Gold	310
30751MT0550095	PPO	Gold	364
30751MT0550096	PPO	Silver	348
30751MT0550097	PPO	Silver	613
30751MT0550100	PPO	Bronze	389
30751MT0550101	PPO	Bronze	168
30751MT0550102	PPO	Gold	n/a
30751MT0550103	PPO	Gold	n/a
30751MT0550104	PPO	Gold	n/a
30751MT0550105	PPO	Gold	n/a
30751MT0670001	POS	Gold	n/a
30751MT0670002	POS	Silver	n/a
30751MT0670003	POS	Bronze	n/a
30751MT0670006	POS	Bronze	n/a
30751MT0670007	POS	Gold	n/a
30751MT0670008	POS	Silver	n/a
30751MT0670009	POS	Bronze	n/a
30751MT0670012	POS	Bronze	n/a
30751MT0670013	POS	Bronze	n/a
30751MT0670016	POS	Bronze	n/a
30751MT0670017	POS	Bronze	n/a
30751MT0670018	POS	Bronze	n/a
30751MT0670019	POS	Bronze	n/a
30751MT0670020	POS	Gold	n/a
30751MT0670021	POS	Gold	n/a
30751MT0670022	POS	Gold	n/a
30751MT0670023	POS	Gold	n/a
30751MT0670024	POS	Silver	n/a
30751MT0670025	POS	Silver	n/a
30751MT0670028	POS	Silver	n/a

Showing 60 of 67 plans; all rows are in the CSV download.

Questions

What counts as a "denied" claim in Blue Cross and Blue Shield of Montana's 39.5% 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 Blue Cross and Blue Shield of Montana claim will be denied?

No. It is an aggregate across all of the issuer's marketplace plans in Montana. Your own claim depends on your plan, the service and the documentation. Compare the rate with the Montana median (5.7%) and read the N before drawing conclusions.

How do I appeal a Blue Cross and Blue Shield of Montana 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, 26.3% of internal appeals to this issuer were overturned (61 of 232). If the internal appeal fails, independent external review is available.

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Cite: Apellica Insurer Denial Report Cards, Blue Cross and Blue Shield of Montana (Montana), 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.