About Denial Facts

We publish what federal data actually says about health insurance claim denials — and the appeal rights almost nobody uses.

The reason this site exists is one pair of numbers: insurers denied 57,590,788 in-network claims in a single year, and 2,336 of those denials were taken to independent external review. That is one in 24,654. Of the people who went, 44% won.

That gap is not a legal problem. It is an information problem. Every one of those 57,590,788 people had the right to a free review by an organization their insurer does not control, whose decision the insurer must obey. Most were never told clearly enough to act on it.

Where the data comes from

CMS Transparency in Coverage Public Use File (PY2024 release, PY2022 claims), data.healthcare.gov — US Government public domain. It covers individual-market Qualified Health Plans on the federal Exchange — 209 insurers across 32 states. Employer and self-funded plans are not in this file; the appeal rights described here still apply to non-grandfathered plans.

Independence

We are not affiliated with, endorsed by, or acting for any insurer, government agency, or independent review organization. We are not a law firm, a medical provider, or an insurance producer. We take no commission from any insurer.

What we sell

Everything on this site is free — the data, the guidance, the deadline calculator. We also sell a $29 Appeal Kit for people who would rather not assemble the paperwork themselves. It is optional, and the free guidance here is genuinely enough to appeal without it.

Corrections

hello@denialfacts.com — we fix errors quickly.