Your health claim was denied. You have two free appeals — and almost nobody uses the second one.
Insurers denied 57,590,788 in-network claims in a single year. Only 2,336 of those denials were taken to independent external review — that is one in every 24,654. Of the people who did, 44% won.
1 in 24,654
denied claims reaches independent review. 44% of those are overturned.
What this means for you: a denial is the insurer's opinion, not the final word. Federal law gives you an internal appeal and, for denials involving medical judgement, a review by an independent organization your insurer does not control — whose decision it must obey. Most people stop after the letter. The few who don't win nearly half the time.
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Find your denial reasonWhat it means, how it is beaten
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The two appeals explainedStep by step
The numbers nobody shows you
| Stage | How many | Overturned |
|---|---|---|
| Claims denied (in-network) | 57,590,788 | — |
| Internal appeals filed | 110,084 | 43% |
| External reviews filed | 2,336 | 44% |
Source: CMS Transparency in Coverage Public Use File (PY2024 release, PY2022 claims), data.healthcare.gov — US Government public domain.
Highest denial rates
Among insurers processing more than 200,000 in-network claims:
| Insurer | State | Denied |
|---|---|---|
| AvMed, Inc. | Florida | 50.2% |
| UnitedHealthcare of Arizona, Inc. | Arizona | 35.8% |
| UnitedHealthcare Insurance Company | Alabama | 35.5% |
| Aetna Health Inc. (a TX corp.) | Texas | 34.1% |
| UnitedHealthcare of Florida, Inc. | Florida | 32.5% |
| UnitedHealthcare of Georgia, Inc. | Georgia | 31.6% |
| UnitedHealthcare Insurance Company | Tennessee | 31% |
| UnitedHealthcare of Texas, Inc. | Texas | 30.1% |
| UnitedHealthcare of North Carolina, Inc | North Carolina | 29.9% |
| Sendero Health Plans, Inc. | Texas | 29.1% |
Everything you need for your appeal: your two deadlines, the argument that fits your denial reason, an evidence checklist, and the external review request. Instant download.
This page presents federal statistics and a general description of appeal rights created by federal law. It is not legal, medical, or insurance advice, and no outcome is guaranteed. Your denial letter and plan documents govern your specific case. Free help is available from your state's Consumer Assistance Program and from the federal Marketplace at HealthCare.gov.