Editorial policy
This page says how the site chooses its sources and how each figure is computed, checked and dated. It also says what the site will not publish, and how to report an error.
What this site covers
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.
Where every figure and rule comes from
- CMS Transparency in Coverage Public Use File: every denial, appeal and overturn figure on this site. The plan-year 2026 release, issued September 26, 2025; downloaded and hashed September 5, 2026.
- 29 CFR 2560.503-1 (eCFR): the claims and appeal deadlines for employer plans. Unchanged at the last weekly pass, October 14, 2026.
- 45 CFR 147.136 (eCFR): internal appeals and external review for individual and group health plans. Unchanged at the last weekly pass, October 14, 2026.
- CCIIO state external review table: which states run their own external review and which use the federal process. Unchanged at the last weekly pass, October 14, 2026.
- California Department of Managed Health Care (DMHC), Independent Medical Review decisions: California external review decisions by type of treatment. Read September 25, 2026.
- Each state insurance department's own consumer page: the consumer helpline and complaint link on each state page. Read September 9, 2026.
- Each insurer's own published appeal policy pages: the appeal procedure quoted on each company page, labeled member or provider. Read August 26, 2026.
- CMS, WISeR Model page: the WISeR prior authorization pages for Original Medicare. Page last modified September 30, 2026.
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.
- Each appeal rule cites and links the regulation or official page it comes from.
- People and machines get the same figures from one dataset. The build fails if a page and the API disagree.
What we will not publish
We never estimate a figure the file does not report, and never predict the outcome of any one appeal. No product is ranked for payment, and the site takes no advertising. We accept no money from any insurer, provider, law firm or agency we write about.
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 policy was last updated October 20, 2026. Who publishes this site is on the About page.
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 (PY2026 release, PY2024 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).