About Denial Facts
We publish what federal data actually says about health insurance claim denials, and the appeal rights that 4,918 of 83,907,852 denials ever reached.
Axion Labs is a family-run independent publishing studio, no affiliation with any insurer, provider, or agency we write about. Contact: hello@getaxionlabs.com.
The reason this site exists is one pair of numbers: insurers denied 83,907,852 in-network claims in a single year, and 4,918 of those denials were taken to independent external review. That is one in 17,061. Of the people who went, 22.2% (1,092 of 4,918; interval 22.2-23.8% for counts CMS withheld; 32.6% without SelectHealth) won.
That gap is not a legal problem. It is an information problem. Every one of those 83,907,852 people had the right to a free review by an organization their insurer does not control, whose decision the insurer must obey. The federal file records 4,918 who did.
Where the data comes from
CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 claims), data.healthcare.gov — US Government public domain. It covers individual-market Qualified Health Plans on the federal Exchange, 152 insurer-state records, 123 companies across 29 states. Employer and self-funded plans are not in this file; the appeal rights described here still apply to non-grandfathered plans.
Which release, and what came after it. The figures on this site are the plan-year 2027 release, issued October 22, 2026, covering plan-year 2025 claims. This is the newest plan year CMS has published: there is no Transparency in Coverage file for a plan year after 2027. The dataset list is at data.healthcare.gov. A test in this site’s build fetches that list every time it runs and fails if CMS publishes a plan year we have not acknowledged here, or if this paragraph ever claims recency by issue date while a later-issued file exists.
What changed between the releases. From the plan-year 2024 release to the plan-year 2026 release, external reviews filed went from 2,336 to 5,881. Overturned reviews went from 32.8% in the plan-year 2026 release to 22.2% in plan-year 2027, or from 32.6% to 32.6% without SelectHealth. We do not compare filed or overturned counts across plan-years 2026 and 2027. Some issuers may have counted pre-service appeals in their 2026 cells. We publish every release so the record is visible: plan-year 2024 (issued April 14, 2025, 2022 claims), 57,590,788 denials, 2,336 external reviews, 44% overturned, 209 insurer-state records across 32 states; plan-year 2025 (issued September 30, 2025, 2023 claims), 85,894,625 denials, 5,000 external reviews, 31.5% overturned, 206 insurer-state records across 31 states; plan-year 2026 (issued September 26, 2025, 2024 claims), 84,502,749 denials, 5,881 external reviews, 32.8% overturned, 185 insurer-state records across 30 states; plan-year 2027 (issued October 22, 2026, 2025 claims), 83,907,852 denials, 4,918 external reviews, 22.2% overturned, 152 insurer-state records across 29 states. Source for each: data.healthcare.gov.
What we do when CMS stops reporting a state or an insurer. The plan-year 2027 file covers 29 states and 152 insurer-state records; the plan-year 2024 file covered 32 and 209. Georgia and Illinois left the file, along with 97 insurer-state records, because they moved off the federal Exchange platform rather than because denials stopped. The two STATE pages stay up with the last figures CMS did report, name that release in their lede and in their source footer, and are left out of every total and every ranking on this site rather than being deleted or padded with dashes. The retired INSURER-STATE URLs are different: each one redirects permanently to the state page for the market it was in, which carries current figures, because a page about one company in one state has nothing current left to say once its rows leave the file. Nothing is deleted in either case, and nothing carried forward is counted in a total.
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 this site covers and how it is checked
Denial Facts covers one subject: denied health insurance claims in the United States. It publishes how often insurers deny in-network claims, by insurer, by state and by the reason given. It also sets out the appeal rights after a denial: the internal appeal, independent external review, and the deadlines for each. The denial figures cover individual-market plans on the federal Exchange only. Employer, Medicaid and Medicare plans are not in that file, and the pages say so. This site gives no legal, medical or insurance advice about any one claim.
Primary sources. The CMS Transparency in Coverage Public Use File supplies every figure. Rules and routes come from the federal claims and appeal regulations on eCFR and the CCIIO external review table. The full list, with the date each was read, is on the editorial policy page.
How a figure is checked and dated. Every denial and appeal figure comes from the CMS workbook itself, through a script we wrote, never from a news story or a summary. The workbook is hashed on download, so a later copy that differs is caught. The page that prints a figure names its source and the plan year it describes. Where the file reports nothing for an insurer or a state, the page says so. It never prints an estimate. Once a week we read the core sources again and compare them with what we published. The home page prints the date of the latest pass and its result.
Corrections. Write to hello@getaxionlabs.com, name the page and the figure, and expect a reply within a few days. If the figure is wrong, we correct the page. The page then says what changed and on what date, and we write back to tell you.
This section was last updated October 20, 2026.
Who runs this
Who we are. Axion Labs is a small, family-run independent publishing studio. We publish plain-English answers built from public records. Every figure names its source and the date we read it. We are not lawyers, not an agency, and not affiliated with any company, insurer, council or government body we write about. We take no commission, no referral fee and no advertising, and we rank no product. Axion Labs writes the pages and answers the mail: hello@getaxionlabs.com.
Denial Facts is run by Axion Labs. One person reads the mail and answers it: hello@getaxionlabs.com.
The same studio also publishes appealsdesk.co.uk (UK parking tickets), nycticketfacts.com (New York City parking tickets), mtdfacts.co.uk (UK Making Tax Digital), screeningfacts.com (background checks). Those sites cover other subjects and share no data with this one.
What we sell
The reference material is free and stays free, the data, the denial-reason pages, the deadline calculator. The $29 Appeal Kit is the part the free pages cannot be: your dates. It works out your internal deadline, your plan's own answer deadline, the day deemed exhaustion triggers if they miss it, and the day your external-review window closes, in order, around your denial. One payment. No subscription. No cut of your claim. 14-day refund, no questions asked.
The federal timeframes: 180 days from the date on the denial notice to file the internal appeal, then 4 months from the final internal denial to request independent external review. Put your date in and get the actual calendar dates, with the days remaining.
Runs entirely in your browser, the date you type is never sent to us and never stored. Open the full calculator →
Or let the $29 Appeal Kit date each step and write the claim-file and external-review requests.
Counts: CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 claims), data.healthcare.gov — US Government public domain. Rights and timeframes: 29 CFR 2560.503-1 (180 days, and your free right to the claim file) and 45 CFR 147.136 (4 months, and what qualifies), explained at HealthCare.gov. Expedited review is decided in about 72 hours under both sections.
Reading either regulation from a script rather than a browser: eCFR answers automated fetches with a challenge page, so the same two sections are mirrored as government PDFs at govinfo.gov (29 CFR 2560.503-1) and govinfo.gov (45 CFR 147.136).