Disputed Claims for FEHB Plans

Along with the customer satisfaction survey results, we have another indicator of service quality for the fee-for-service plans. We checked “disputed claims” on file at OPM. A “disputed claim” is a case in which a plan member has been denied benefits and has followed the required procedure to appeal the denial to OPM.

Our ratings tables show disputed claims per 10,000 Federal enrollees for the period from October 2019 through September 2020. We also report how many cases per 10,000 enrollees a plan’s initial decision in a disputed claim was changed or reversed. The disputed claim information is shown for national plans.

*These plans not open to all.