{
 "cite": {
  "title": "Health insurance claim denial rates and external-review routes, by state",
  "url": "https://denialfacts.com/states",
  "publisher": "Axion Labs — Denial Facts",
  "checked": "2026-11-04",
  "dataset": {
   "version": "2026-11-04",
   "fixity": "sha256-cda2f9b89c8dde2a74989a35dbe7c0d08ff35dac5456484dc1c03c1b181a67b6"
  },
  "source": {
   "name": "CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 claims), data.healthcare.gov",
   "url": "https://data.healthcare.gov/"
  },
  "rule": "45 CFR 147.136",
  "license": "free to quote with the URL",
  "receipt": null
 },
 "attribution": {
  "source": "Denial Facts (https://denialfacts.com) — computed from the CMS Transparency in Coverage Public Use File",
  "upstream": "CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 claims), data.healthcare.gov — US Government public domain",
  "upstream_license": "US Government public domain",
  "facts_checked": "August 3, 2026",
  "license": "Free to use, including commercially, with attribution and a link to https://denialfacts.com",
  "operator": {
   "name": "Axion Labs",
   "email": "hello@getaxionlabs.com"
  },
  "disclaimer": "Federal statistics and a general description of appeal rights created by federal law. Not legal, medical, or insurance advice, and no outcome is guaranteed. Your denial letter and plan documents govern your specific case."
 },
 "count": 32,
 "federal_route_states": [
  "Alabama",
  "Florida",
  "Georgia",
  "Texas",
  "Wisconsin",
  "American Samoa",
  "Guam",
  "Northern Mariana Islands",
  "Virgin Islands"
 ],
 "ferp_paused_from": "July 1, 2026",
 "ferp_reopened_on": "July 31, 2026",
 "ferp_extension_deadline": "October 2, 2026",
 "ferp_extension_passed": true,
 "ferp_source_url": "https://www.cms.gov/CCIIO/Resources/Files/external_appeals",
 "external_review_route_applies_to": "insured_plans_only",
 "self_funded_employer_plan_route": "federal",
 "self_funded_note": "This route is the one for insured plans, Marketplace, individual, and employer plans where an insurance company carries the risk. If your coverage is through a job and the employer pays the claims itself (a self-funded or self-insured plan, which is 63% of covered workers), the state process does not apply to you whatever your state operates, and your external review goes through the federal process instead. Your denial letter names your route; if it does not, ask your plan in writing whether the plan is self-funded.",
 "note": "Query one with /api/answer?state={XX or slug}. Combine with &insurer= and &reason=.",
 "states": [
  {
   "code": "AL",
   "name": "Alabama",
   "slug": "alabama",
   "denial_rate_pct": 16.3,
   "claims_denied": 4616569,
   "external_reviews_filed": 32,
   "external_review_route": "federal",
   "page": "https://denialfacts.com/states/alabama",
   "answer": "https://denialfacts.com/api/answer?state=AL"
  },
  {
   "code": "AK",
   "name": "Alaska",
   "slug": "alaska",
   "denial_rate_pct": 24.8,
   "claims_denied": 245546,
   "external_reviews_filed": 0,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/alaska",
   "answer": "https://denialfacts.com/api/answer?state=AK"
  },
  {
   "code": "AZ",
   "name": "Arizona",
   "slug": "arizona",
   "denial_rate_pct": 16.1,
   "claims_denied": 1449189,
   "external_reviews_filed": 294,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/arizona",
   "answer": "https://denialfacts.com/api/answer?state=AZ"
  },
  {
   "code": "AR",
   "name": "Arkansas",
   "slug": "arkansas",
   "denial_rate_pct": 13.5,
   "claims_denied": 1437735,
   "external_reviews_filed": 0,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/arkansas",
   "answer": "https://denialfacts.com/api/answer?state=AR"
  },
  {
   "code": "DE",
   "name": "Delaware",
   "slug": "delaware",
   "denial_rate_pct": 20.3,
   "claims_denied": 449381,
   "external_reviews_filed": 0,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/delaware",
   "answer": "https://denialfacts.com/api/answer?state=DE"
  },
  {
   "code": "FL",
   "name": "Florida",
   "slug": "florida",
   "denial_rate_pct": 13.5,
   "claims_denied": 17515496,
   "external_reviews_filed": 269,
   "external_review_route": "federal",
   "page": "https://denialfacts.com/states/florida",
   "answer": "https://denialfacts.com/api/answer?state=FL"
  },
  {
   "code": "HI",
   "name": "Hawaii",
   "slug": "hawaii",
   "denial_rate_pct": 26.3,
   "claims_denied": 203127,
   "external_reviews_filed": 0,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/hawaii",
   "answer": "https://denialfacts.com/api/answer?state=HI"
  },
  {
   "code": "IN",
   "name": "Indiana",
   "slug": "indiana",
   "denial_rate_pct": 10.6,
   "claims_denied": 973293,
   "external_reviews_filed": 81,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/indiana",
   "answer": "https://denialfacts.com/api/answer?state=IN"
  },
  {
   "code": "IA",
   "name": "Iowa",
   "slug": "iowa",
   "denial_rate_pct": 17.7,
   "claims_denied": 915031,
   "external_reviews_filed": 37,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/iowa",
   "answer": "https://denialfacts.com/api/answer?state=IA"
  },
  {
   "code": "KS",
   "name": "Kansas",
   "slug": "kansas",
   "denial_rate_pct": 12.7,
   "claims_denied": 969532,
   "external_reviews_filed": 57,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/kansas",
   "answer": "https://denialfacts.com/api/answer?state=KS"
  },
  {
   "code": "LA",
   "name": "Louisiana",
   "slug": "louisiana",
   "denial_rate_pct": 18.7,
   "claims_denied": 2363981,
   "external_reviews_filed": 211,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/louisiana",
   "answer": "https://denialfacts.com/api/answer?state=LA"
  },
  {
   "code": "MI",
   "name": "Michigan",
   "slug": "michigan",
   "denial_rate_pct": 17.7,
   "claims_denied": 2967990,
   "external_reviews_filed": 119,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/michigan",
   "answer": "https://denialfacts.com/api/answer?state=MI"
  },
  {
   "code": "MS",
   "name": "Mississippi",
   "slug": "mississippi",
   "denial_rate_pct": 11.2,
   "claims_denied": 1141675,
   "external_reviews_filed": 0,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/mississippi",
   "answer": "https://denialfacts.com/api/answer?state=MS"
  },
  {
   "code": "MO",
   "name": "Missouri",
   "slug": "missouri",
   "denial_rate_pct": 11.7,
   "claims_denied": 1592551,
   "external_reviews_filed": 12,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/missouri",
   "answer": "https://denialfacts.com/api/answer?state=MO"
  },
  {
   "code": "MT",
   "name": "Montana",
   "slug": "montana",
   "denial_rate_pct": 12.7,
   "claims_denied": 323019,
   "external_reviews_filed": 0,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/montana",
   "answer": "https://denialfacts.com/api/answer?state=MT"
  },
  {
   "code": "NE",
   "name": "Nebraska",
   "slug": "nebraska",
   "denial_rate_pct": 16.6,
   "claims_denied": 325332,
   "external_reviews_filed": 12,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/nebraska",
   "answer": "https://denialfacts.com/api/answer?state=NE"
  },
  {
   "code": "NH",
   "name": "New Hampshire",
   "slug": "new-hampshire",
   "denial_rate_pct": 8,
   "claims_denied": 158490,
   "external_reviews_filed": 0,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/new-hampshire",
   "answer": "https://denialfacts.com/api/answer?state=NH"
  },
  {
   "code": "NC",
   "name": "North Carolina",
   "slug": "north-carolina",
   "denial_rate_pct": 19.7,
   "claims_denied": 5857465,
   "external_reviews_filed": 121,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/north-carolina",
   "answer": "https://denialfacts.com/api/answer?state=NC"
  },
  {
   "code": "ND",
   "name": "North Dakota",
   "slug": "north-dakota",
   "denial_rate_pct": 6.8,
   "claims_denied": 105786,
   "external_reviews_filed": 0,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/north-dakota",
   "answer": "https://denialfacts.com/api/answer?state=ND"
  },
  {
   "code": "OH",
   "name": "Ohio",
   "slug": "ohio",
   "denial_rate_pct": 12.7,
   "claims_denied": 1509307,
   "external_reviews_filed": 114,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/ohio",
   "answer": "https://denialfacts.com/api/answer?state=OH"
  },
  {
   "code": "OK",
   "name": "Oklahoma",
   "slug": "oklahoma",
   "denial_rate_pct": 17,
   "claims_denied": 2116240,
   "external_reviews_filed": 34,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/oklahoma",
   "answer": "https://denialfacts.com/api/answer?state=OK"
  },
  {
   "code": "SC",
   "name": "South Carolina",
   "slug": "south-carolina",
   "denial_rate_pct": 15.7,
   "claims_denied": 3573275,
   "external_reviews_filed": 261,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/south-carolina",
   "answer": "https://denialfacts.com/api/answer?state=SC"
  },
  {
   "code": "SD",
   "name": "South Dakota",
   "slug": "south-dakota",
   "denial_rate_pct": 5.9,
   "claims_denied": 95138,
   "external_reviews_filed": 0,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/south-dakota",
   "answer": "https://denialfacts.com/api/answer?state=SD"
  },
  {
   "code": "TN",
   "name": "Tennessee",
   "slug": "tennessee",
   "denial_rate_pct": 17.5,
   "claims_denied": 3896627,
   "external_reviews_filed": 66,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/tennessee",
   "answer": "https://denialfacts.com/api/answer?state=TN"
  },
  {
   "code": "TX",
   "name": "Texas",
   "slug": "texas",
   "denial_rate_pct": 17.3,
   "claims_denied": 24184622,
   "external_reviews_filed": 158,
   "external_review_route": "federal",
   "page": "https://denialfacts.com/states/texas",
   "answer": "https://denialfacts.com/api/answer?state=TX"
  },
  {
   "code": "UT",
   "name": "Utah",
   "slug": "utah",
   "denial_rate_pct": 17.3,
   "claims_denied": 1967874,
   "external_reviews_filed": 3028,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/utah",
   "answer": "https://denialfacts.com/api/answer?state=UT"
  },
  {
   "code": "WV",
   "name": "West Virginia",
   "slug": "west-virginia",
   "denial_rate_pct": 20.1,
   "claims_denied": 707610,
   "external_reviews_filed": 0,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/west-virginia",
   "answer": "https://denialfacts.com/api/answer?state=WV"
  },
  {
   "code": "WI",
   "name": "Wisconsin",
   "slug": "wisconsin",
   "denial_rate_pct": 15.4,
   "claims_denied": 1893070,
   "external_reviews_filed": 12,
   "external_review_route": "federal",
   "page": "https://denialfacts.com/states/wisconsin",
   "answer": "https://denialfacts.com/api/answer?state=WI"
  },
  {
   "code": "WY",
   "name": "Wyoming",
   "slug": "wyoming",
   "denial_rate_pct": 20.2,
   "claims_denied": 352901,
   "external_reviews_filed": 0,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/wyoming",
   "answer": "https://denialfacts.com/api/answer?state=WY"
  },
  {
   "code": "OR",
   "name": "Oregon",
   "slug": "oregon",
   "denial_rate_pct": 10.9,
   "claims_denied": 277498,
   "external_reviews_filed": 47,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/oregon",
   "answer": "https://denialfacts.com/api/answer?state=OR"
  },
  {
   "code": "IL",
   "name": "Illinois",
   "slug": "illinois",
   "denial_rate_pct": 19.6,
   "claims_denied": 2948254,
   "external_reviews_filed": 113,
   "external_review_route": "state",
   "page": "https://denialfacts.com/states/illinois",
   "answer": "https://denialfacts.com/api/answer?state=IL"
  },
  {
   "code": "GA",
   "name": "Georgia",
   "slug": "georgia",
   "denial_rate_pct": 15.8,
   "claims_denied": 4235210,
   "external_reviews_filed": 23,
   "external_review_route": "federal",
   "page": "https://denialfacts.com/states/georgia",
   "answer": "https://denialfacts.com/api/answer?state=GA"
  }
 ]
}