InsuranceComplaintCheck

Oscar Health — Insurance Complaint Report

Oscar Health: High Complaints with Coverage Gaps and Authorizations

Key Metrics

  • Total Complaints: 849
  • NAIC Complaint Ratio: 1.45
  • Market Share: 0.5%
  • AI Risk Score: 85/100
  • Most Recent Complaint: 2021-05-28

AI Insurer Analysis

Oscar Health has accumulated 849 insurance complaints on record. Their NAIC complaint ratio of 1.45 is above average, meaning they receive more complaints than expected for an insurer of their market size. With approximately 0.5% market share, Oscar Health is a smaller player in the insurance market. The most common complaint categories are: health (20). Oscar Health has a high complaint ratio and frequent coverage gaps and prior authorizations issues. The insurer has seen a recent uptick in complaints, particularly in coverage gaps and prior authorizations. Complaints are spread across multiple states, indicating a widespread issue rather than a localized problem. Trend shows increasing complaints, particularly in coverage gaps and prior authorizations. Areas of concern include: Frequent claim denials; High number of coverage gaps and prior authorizations issues. On the positive side: Recent uptick in complaints.

Risk Breakdown

  • regulatoryActions: none
  • complaintRatio: high
  • claimDenialRate: moderate
  • responseTime: fair

Red Flags

  • Frequent claim denials
  • High number of coverage gaps and prior authorizations issues

Green Flags

  • Recent uptick in complaints

Consumer Tips

When dealing with Oscar Health, keep these practical tips in mind: 1. Check your coverage details carefully before enrolling. 2. Be proactive in seeking second opinions for prior authorizations. 3. Review your policy regularly for any changes in coverage. Before purchasing a policy, compare Oscar Health's complaint ratio (1.45, above average) with competitors offering similar coverage. Always read the full policy document, paying attention to exclusions and limitations. Document all communications with the insurer in writing. If you experience a dispute, file a complaint with your state Department of Insurance — it is free and often results in faster resolution.

Trend Analysis

Trend shows increasing complaints, particularly in coverage gaps and prior authorizations.

Frequently Asked Questions about Oscar Health

Is Oscar Health a good insurance company?

Oscar Health has 849 complaints on record. Their NAIC complaint ratio is 1.45, which is above average. They hold approximately 0.5% market share. A complaint ratio below 1.00 indicates fewer complaints than expected for a company of this size; above 1.00 indicates more.

What are the most common complaints about Oscar Health?

The most common complaint categories for Oscar Health are: health (20). The leading specific issues are: Coverage gap (5), Prior authorization (4), Network dispute (4).

How does Oscar Health compare to competitors?

Oscar Health's NAIC complaint ratio of 1.45 is above average. Companies with ratios below 1.00 receive fewer complaints relative to their size. When comparing insurers, also consider financial strength ratings, coverage options, and premium pricing alongside complaint data.

Should I file a DOI complaint against Oscar Health?

If you have an unresolved dispute with Oscar Health, filing a complaint with your state Department of Insurance (DOI) is a free and effective option. Steps: (1) Gather all documentation including your policy, correspondence, and claim records. (2) Contact your state DOI — most Oscar Health complaints come from South Dakota. (3) File online or by mail. (4) The DOI typically responds within 30-45 days.

Are Oscar Health complaints getting better or worse?

Oscar Health has 849 total complaints. In the most recent data, 20 complaints were recorded across 1 coverage categories. Check the NAIC Consumer Information Source for the most current complaint ratio trends.

What insurance companies have the lowest complaint ratios?

Insurance companies with the lowest complaint ratios typically include mutual insurers and member-owned companies. To find alternatives to Oscar Health, compare NAIC complaint ratios for companies offering the same coverage types (health, etc.). Your state DOI website provides complaint data specific to companies licensed in your state.

Has Oscar Health been fined or sanctioned by insurance regulators?

Regulatory action information is available through your state Department of Insurance and the NAIC. Oscar Health has 849 consumer complaints on record with a complaint ratio of 1.45. For specific regulatory actions, check the NAIC Regulatory Actions database and your state DOI enforcement records.

Which states have the most complaints against Oscar Health?

The states with the most complaints against Oscar Health are: South Dakota (2), Arizona (2), Alabama (2), Kansas (2), Connecticut (1). This distribution may reflect the company's market presence in those states rather than indicating worse service in specific locations.

What patterns emerge from Oscar Health's complaint data?

Oscar Health has a high complaint ratio compared to industry standards.

How does Oscar Health handle claims compared to peers?

Coverage gaps and prior authorizations are the most frequent complaint types.

What is the complaint trend for Oscar Health?

Trend shows increasing complaints, particularly in coverage gaps and prior authorizations.

What should prospective policyholders know about Oscar Health?

Complaints are not limited to a single state, suggesting a systemic issue.

Are there systemic issues in Oscar Health's complaint history?

The insurer has seen a recent increase in complaints, indicating potential ongoing issues.

Recent Complaints Against Oscar Health

Oscar Health Complaints by State

Oscar Health Complaints by Coverage Type

Browse Oscar Health Complaints by State

Browse Oscar Health Complaints by Category

Explore More

This analysis is based on NAIC complaint data and AI interpretation. Not legal, financial, or insurance advice.