Blue Cross Blue Shield of Oklahoma (Oklahoma) in-network claim denial rate: 23.4%

In the CMS Transparency in Coverage file for plan year 2025, Blue Cross Blue Shield of Oklahoma reported denying 1,960,087 of 8,359,015 in-network claims (23.4%) in Oklahoma, from 2023 claims. 23.8% of internal appeals were overturned (376 of 1,581). That is the 3rd highest reported rate of 6 ranked issuers in Oklahoma; the state median is 22.5%.

Denial rate

23.4%

1,960,087 of 8,359,015 claims

Appeals overturned

23.8%

376 of 1,581 filed

External review overturned

37.3%

22 of 59 filed

Prior file (plan year 2024, 2022 claims): denial rate 14.9% (1,144,634 of 7,664,353); appeal overturn rate 27.6%.

Compared with Oklahoma and the national median

Measure	Blue Cross Blue Shield of Oklahoma	Oklahoma median	National median
In-network denial rate	23.4%	22.5%	18.3%
In-network claims received	8,359,015	—	—
Internal appeals filed	1,581	—	—
Internal appeal overturn rate	23.8%	37.0%	41.7%
External reviews filed	59	—	—
External review overturn rate	37.3%	0.0%	0.0%
Out-of-network denial rate	34.7%	—	—

Medians are across issuers with at least 1,000 in-network claims received in the same file (Oklahoma: 6 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.bcbsok.com/insurance-basics/coverage-information/transparency-in-coverage.

If Blue Cross Blue Shield of Oklahoma 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 (88)

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)
87571OK0350068	PPO	Bronze	6,065
87571OK0350069	PPO	Silver	34,124
87571OK0350070	PPO	Bronze	14,016
87571OK0350083	PPO	Bronze	2,247
87571OK0350084	PPO	Bronze	44,684
87571OK0350085	PPO	Bronze	40,308
87571OK0350086	PPO	Bronze	52,399
87571OK0350087	PPO	Silver	14,144
87571OK0350088	PPO	Silver	56,482
87571OK0350089	PPO	Silver	71,569
87571OK0350090	PPO	Silver	234,310
87571OK0350091	PPO	Bronze	9,529
87571OK0350092	PPO	Bronze	169,283
87571OK0350093	PPO	Bronze	191,655
87571OK0350094	PPO	Bronze	157,991
87571OK0350097	PPO	Gold	12,993
87571OK0350106	PPO	Gold	4,296
87571OK0350107	PPO	Gold	44,250
87571OK0350108	PPO	Gold	27,116
87571OK0350109	PPO	Gold	92,264
87571OK0350115	PPO	Silver	92,456
87571OK0350118	PPO	Gold	11,442
87571OK0350127	PPO	Gold	3,705
87571OK0350128	PPO	Gold	50,458
87571OK0350129	PPO	Gold	27,094
87571OK0350130	PPO	Gold	96,194
87571OK0350165	PPO	Catastrophic	n/a
87571OK0350171	PPO	Gold	n/a
87571OK0350172	PPO	Silver	n/a
87571OK0350173	PPO	Bronze	n/a
87571OK0350176	PPO	Bronze	n/a
87571OK0350177	PPO	Silver	n/a
87571OK0350178	PPO	Gold	n/a
87571OK0350191	PPO	Bronze	n/a
87571OK0350192	PPO	Bronze	n/a
87571OK0350193	PPO	Bronze	n/a
87571OK0350194	PPO	Bronze	n/a
87571OK0350199	PPO	Gold	n/a
87571OK0350200	PPO	Gold	n/a
87571OK0350201	PPO	Gold	n/a
87571OK0350202	PPO	Gold	n/a
87571OK0350203	PPO	Catastrophic	n/a
87571OK0350204	PPO	Catastrophic	n/a
87571OK0350205	PPO	Catastrophic	n/a
87571OK0350206	PPO	Catastrophic	n/a
87571OK0350215	PPO	Silver	n/a
87571OK0350216	PPO	Silver	n/a
87571OK0350217	PPO	Silver	n/a
87571OK0350218	PPO	Silver	n/a
87571OK0350219	PPO	Bronze	n/a
87571OK0350220	PPO	Bronze	n/a
87571OK0350221	PPO	Bronze	n/a
87571OK0350222	PPO	Bronze	n/a
87571OK0350223	PPO	Silver	n/a
87571OK0350224	PPO	Silver	n/a
87571OK0350225	PPO	Silver	n/a
87571OK0350226	PPO	Silver	n/a
87571OK0350227	PPO	Gold	n/a
87571OK0350228	PPO	Gold	n/a
87571OK0350229	PPO	Gold	n/a

Showing 60 of 88 plans; all rows are in the CSV download.

Questions

What counts as a "denied" claim in Blue Cross Blue Shield of Oklahoma's 23.4% 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 Blue Shield of Oklahoma claim will be denied?

No. It is an aggregate across all of the issuer's marketplace plans in Oklahoma. Your own claim depends on your plan, the service and the documentation. Compare the rate with the Oklahoma median (22.5%) and read the N before drawing conclusions.

How do I appeal a Blue Cross Blue Shield of Oklahoma 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, 23.8% of internal appeals to this issuer were overturned (376 of 1,581). If the internal appeal fails, independent external review is available.

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