Where independent external review goes unused
External review is free, decided by an organization your insurer does not control, and binding on the plan. Nationally it is used once for every 14,369 denials, and 32.8% of the reviews that happen are overturned. This page lists the insurers with the largest volume of denials, and shows against each how little that stage was used.
Largest denial volumes, with how rarely external review was reached
| Insurer | State | Claims denied | External reviews | Denials per review |
|---|---|---|---|---|
| Blue Cross Blue Shield of Texas | Texas | 11,028,737 | 808 | 1 in 13,649 |
| Health Options, Inc. | Florida | 10,507,969 | 153 | 1 in 68,680 |
| Blue Cross and Blue Shield of Florida | Florida | 4,251,990 | 170 | 1 in 25,012 |
| Blue Cross and Blue Shield of NC | North Carolina | 3,116,071 | 88 | 1 in 35,410 |
| Celtic Insurance Company | Texas | 2,652,607 | 237 | 1 in 11,192 |
| UnitedHealthcare of Texas, Inc. | Texas | 2,550,560 | 67 | 1 in 38,068 |
| Blue Cross and Blue Shield of Alabama | Alabama | 2,038,603 | 13 | 1 in 156,816 |
| Blue Cross and Blue Shield of South Carolina | South Carolina | 1,827,005 | 234 | 1 in 7,808 |
| Ambetter of Magnolia Inc. | Mississippi | 1,824,195 | 0 | none filed |
| SelectHealth, Inc. | Utah | 1,571,221 | 119 | 1 in 13,204 |
| Community Health Choice, Inc. | Texas | 1,449,319 | 26 | 1 in 55,743 |
| Blue Cross Blue Shield of Oklahoma | Oklahoma | 1,385,537 | 50 | 1 in 27,711 |
| Celtic Insurance Company | Arkansas | 1,297,980 | 0 | none filed |
| Superior Health Plan | Texas | 1,287,305 | 62 | 1 in 20,763 |
| Scott and White Health Plan | Texas | 1,205,777 | 170 | 1 in 7,093 |
| Celtic Insurance Company | Missouri | 1,113,385 | 0 | none filed |
| HMO Louisiana, Inc. | Louisiana | 993,016 | 247 | 1 in 4,020 |
| Cigna Health and Life Insurance Company | Florida | 926,080 | 15 | 1 in 61,739 |
| Oscar Insurance Company | Texas | 764,285 | 517 | 1 in 1,478 |
| Celtic Insurance Company | Kansas | 734,165 | 17 | 1 in 43,186 |
| UnitedHealthcare of Florida, Inc. | Florida | 719,832 | 18 | 1 in 39,991 |
| USAble Mutual Insurance Company | Arkansas | 669,702 | 35 | 1 in 19,134 |
| UnitedHealthcare of Arizona, Inc. | Arizona | 646,181 | 33 | 1 in 19,581 |
| CareSource Indiana, Inc. | Indiana | 638,511 | 436 | 1 in 1,464 |
| Blue Care Network of Michigan | Michigan | 630,298 | 65 | 1 in 9,697 |
| Florida Health Care Plan, Inc. | Florida | 602,771 | 36 | 1 in 16,744 |
| CareSource Ohio, Inc. | Ohio | 562,546 | 263 | 1 in 2,139 |
| Health First Commercial Plans, Inc. | Florida | 475,722 | 37 | 1 in 12,857 |
| Molina Healthcare of Florida, Inc | Florida | 341,296 | 0 | none filed |
| Oscar Buckeye State Insurance Corp. | Ohio | 337,922 | 394 | 1 in 858 |
| Healthy Alliance Life Co(Anthem BCBS) | Missouri | 295,802 | 0 | none filed |
| Medica Insurance Company | Nebraska | 281,819 | 11 | 1 in 25,620 |
| QualChoice Life & Health Insurance Company, Inc. | Arkansas | 262,731 | 0 | none filed |
| Security Health Plan of Wisconsin, Inc. | Wisconsin | 247,191 | 0 | none filed |
| QCA Health Plan, Inc. | Arkansas | 245,717 | 0 | none filed |
| Molina Healthcare of Texas, Inc. | Texas | 237,126 | 21 | 1 in 11,292 |
| Blue Cross Blue Shield of Michigan Mutual Insurance Company | Michigan | 236,257 | 78 | 1 in 3,029 |
| Blue Cross and Blue Shield of Arizona, Inc. | Arizona | 233,016 | 180 | 1 in 1,295 |
| MOLINA HEALTHCARE OF SOUTH CAROLINA, INC | South Carolina | 230,150 | 0 | none filed |
| UnitedHealthcare of Ohio, Inc. | Ohio | 208,089 | 21 | 1 in 9,909 |
Top 40 by volume of denials, of 100 insurer records reporting both figures. Source: CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 claims), data.healthcare.gov — US Government public domain.
States where not one denial reached external review
Alaska (239,313 denied) · Delaware (440,631 denied) · Hawaii (198,653 denied) · Mississippi (2,725,739 denied) · New Hampshire (321,334 denied) · North Dakota (140,595 denied) · South Dakota (112,411 denied) · Wisconsin (1,188,325 denied) · Wyoming (229,909 denied)
- We cannot overturn your denial. Only your plan, or an independent reviewer, can do that.
- We cannot make your plan cover a service it genuinely excludes.
- We cannot guarantee external review applies to your denial. It covers medical judgment, experimental or investigational determinations, and rescission, a purely administrative denial may not qualify, and we say so on those pages rather than selling you past it.
- We have no customer testimonials and publish none. Our evidence is the federal dataset and the regulation cites, both of which you can check.
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 →
This page exists because of one gap, and that gap is the reason the site exists at all: the stage that actually overturns denials is free, binding on the plan, and used once for every 14,369 denials. Read the last column against the first. A large denial count can simply mean a large book of business. A large denial count with no independent reviews behind it is a different thing, and it is worth knowing which of the two sent your letter.
, Andrew at Axion Labs · hello@getaxionlabs.comEverything you need for your appeal: your two deadlines, the argument that fits your denial reason, the letters, the clinician brief, and the external review request. One payment. No subscription. No cut of your claim. Opens on screen the moment you pay. 14-day refund, no questions, one email to hello@getaxionlabs.com.
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).