Molina Healthcare of Ohio, Inc. (Ohio) in-network claim denial rate: 21.7%

In the CMS Transparency in Coverage file for plan year 2026, Molina Healthcare of Ohio, Inc. reported denying 428,806 of 1,975,213 in-network claims (21.7%) in Ohio, from 2024 claims. 50.0% of internal appeals were overturned (108 of 216). That is the 4th highest reported rate of 10 ranked issuers in Ohio; the state median is 20.0%.

Denial rate

21.7%

428,806 of 1,975,213 claims

Appeals overturned

50.0%

108 of 216 filed

External review overturned

n/a

not reported

Prior file (plan year 2025, 2023 claims): denial rate 24.1% (294,198 of 1,220,402); appeal overturn rate 29.6%.

Compared with Ohio and the national median

Measure	Molina Healthcare of Ohio, Inc.	Ohio median	National median
In-network denial rate	21.7%	20.0%	19.0%
In-network claims received	1,975,213	—	—
Internal appeals filed	216	—	—
Internal appeal overturn rate	50.0%	42.5%	37.7%
External reviews filed	n/a	—	—
External review overturn rate	n/a	21.7%	0.0%
Out-of-network denial rate	41.6%	—	—

Medians are across issuers with at least 1,000 in-network claims received in the same file (Ohio: 10 issuers; national: 158 issuers in 32 states). Plan year 2026 file, 2024 claims.

Read these numbers carefully

Reporting lag: the CMS public-use file for a plan year reports claims from two plan years earlier (the PY2026 file carries 2024 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 2026; data dictionary. Issuer's own claims-payment policy page: https://www.molinamarketplace.com/marketplace/oh/en-us/FAQ.aspx.

If Molina Healthcare of Ohio, Inc. 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.

Compare this issuer

Other issuers in Ohio

Buckeye Community Health Plan 19.5%
Community Insurance Company(Anthem BCBS) 8.3%
CareSource Ohio, Inc. 20.0%
Medical Health Insuring Corp. of Ohio 15.0%
Oscar Buckeye State Insurance Corp. 26.5%
UnitedHealthcare of Ohio, Inc. 23.2%
Oscar Insurance Corporation of Ohio 19.9%
AultCare Insurance Company 19.6%
Summa Insurance Company, Inc. 26.1%
Paramount Insurance Company 14.2%
Aetna Health Inc. (a PA corp.) n/a
Antidote Health Plan of Ohio n/a

Molina Healthcare filings in other states

Plans in this filing (22)

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)
64353OH0010001	HMO	Gold	16,258
64353OH0010002	HMO	Silver	108,622
64353OH0010008	HMO	Gold	4,646
64353OH0010009	HMO	Silver	234,627
64353OH0010010	HMO	Silver	30,264
64353OH0010011	HMO	Bronze	n/a
64353OH0010012	HMO	Bronze	n/a
64353OH0010013	HMO	Bronze	n/a
64353OH0010014	HMO	Gold	n/a
64353OH0040001	HMO	Gold	6,134
64353OH0040002	HMO	Silver	28,255
64353OH0040004	HMO	Bronze	n/a
64353OH0040005	HMO	Gold	n/a
64353OH0040012	HMO	Bronze	n/a
64353OH0060001	HMO	Gold	n/a
64353OH0060002	HMO	Silver	n/a
64353OH0060003	HMO	Bronze	n/a
64353OH0060004	HMO	Bronze	n/a
64353OH0060005	HMO	Gold	n/a
64353OH0070001	HMO	Bronze	n/a
64353OH0070002	HMO	Gold	n/a
64353OH0070003	HMO	Silver	n/a

Questions

What counts as a "denied" claim in Molina Healthcare of Ohio, Inc.'s 21.7% rate?

Every in-network claim the issuer reported as denied in the 2024 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 2024 when the file is for plan year 2026?

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 Molina Healthcare of Ohio, Inc. claim will be denied?

No. It is an aggregate across all of the issuer's marketplace plans in Ohio. Your own claim depends on your plan, the service and the documentation. Compare the rate with the Ohio median (20.0%) and read the N before drawing conclusions.

How do I appeal a Molina Healthcare of Ohio, Inc. 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, 50.0% of internal appeals to this issuer were overturned (108 of 216). If the internal appeal fails, independent external review is available.

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Cite: Apellica Insurer Denial Report Cards, Molina Healthcare of Ohio, Inc. (Ohio), plan year 2026, 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.