--- title: "Insurance claim denied? Your two dates, free" url: "https://denialfacts.com/" publisher: "Axion Labs — Denial Facts" checked: "2026-11-04" dataset_fixity: "sha256-cda2f9b89c8dde2a74989a35dbe7c0d08ff35dac5456484dc1c03c1b181a67b6" --- # Claim denied? You can still appeal, and we help you do it. Insurers denied 83,907,852 in-network claims in a single year. Only 4,918 of those denials were taken to independent external review, one in every 17,061. Of the people who did, 22.2% (1,092 of 4,918; interval 22.2-23.8% for counts CMS withheld; 32.6% without SelectHealth) won. ## Figures | Figure | Value | | --- | --- | | In-network claims denied | 83,907,852 | | National denial rate | 15.7% | | Internal appeals filed | 241,596 | | External reviews filed | 4,918 | | Of those, overturned | 22.2% | ## Free help, and one paid kit for $29 The $29 Appeal Kit: your deadlines, 3 letters and a page for your doctor, on screen after you pay. It starts from your denial letter's date, and all 3 letters are ready to finish. Print it or save it as a PDF, and we email you the link. The deadline clock is the product: the Kit sets your dates beside the days your plan has to answer. Get my Appeal Kit, $29: https://denialfacts.com/appeal-kit. Start free: the date on your notice gives you both federal deadlines, 180 days and 4 months, as dates. ## Before you start What you will need: Your denial notice; the date printed on it, which starts both deadlines; your insurance card; and the reason the notice gives, word for word. How long it takes: about 7 minutes for the free tool above, counted field by field with the RateMyPDF field timings (Steenhuis, Willey and Colarusso, ICAIL 2023) (https://assemblyline.suffolklitlab.org/assets/files/Beyond%20Readability%20with%20RateMyPDF-306d8c3ae5c5cb2ff33d436a859d1581.pdf). Because two answers come off your notice, they take the time; the other two you know by heart. "I do not know which" is an answer to who pays on denialfacts, never a dead end. The fields, and the kind of answer each one is: Date on your denial notice (gathered); Who pays your claims (slot-in); Which state (slot-in); The reason your letter gives (gathered). Where this page sits: 1. Understand (https://denialfacts.com/what-happened); 2. Check your dates (this page); 3. Gather (https://denialfacts.com/insurance-denial-letter); 4. Act (https://denialfacts.com/appeal-letter). Sources re-checked November 5, 2026: 5 of 5 unchanged. ## The numbers nobody shows you | Stage | How many | Overturned | | --- | --- | --- | | Claims denied (in-network) | 83,907,852 | | | Internal appeals filed | 241,596 | 26.8% | | External reviews filed | 4,918 | 22.2% | ## Highest denial rates (insurers processing more than 200,000 in-network claims) | Insurer | State | Denied | Page | | --- | --- | --- | --- | | Capital Health Plan | Florida | 96.2% | https://denialfacts.com/insurers/capital-health-plan--fl | | Blue Care Network of Michigan | Michigan | 30.9% | https://denialfacts.com/insurers/blue-care-network-of-michigan--mi | | Select Health of South Carolina | South Carolina | 29.9% | https://denialfacts.com/insurers/select-health-of-south-carolina--sc | | AmeriHealth Caritas VIP Next, Inc. | Delaware | 29.3% | https://denialfacts.com/insurers/amerihealth-caritas-vip-next-inc--de | | Premera Blue Cross Blue Shield of Alaska | Alaska | 26.3% | https://denialfacts.com/insurers/premera-blue-cross-blue-shield-of-alaska--ak | | Hawaii Medical Service Association | Hawaii | 26.3% | https://denialfacts.com/insurers/hawaii-medical-service-association--hi | | AmeriHealth Caritas North Carolina, Inc. | North Carolina | 26.2% | https://denialfacts.com/insurers/amerihealth-caritas-north-carolina-inc--nc | | UnitedHealthcare of Oklahoma, Inc. | Oklahoma | 25.4% | https://denialfacts.com/insurers/unitedhealthcare-of-oklahoma-inc--ok | | AvMed, Inc. | Florida | 24.7% | https://denialfacts.com/insurers/avmed-inc--fl | | UnitedHealthcare of Arizona, Inc. | Arizona | 24.5% | https://denialfacts.com/insurers/unitedhealthcare-of-arizona-inc--az | ## Start here Find your insurer 123 companies, 152 state records Find your denial reason What it means, how it is beaten Check your deadlines Free calculator The two appeals explained Step by step Where external review goes unused The gap, insurer by insurer ## Questions people ask before they appeal | Question | Answer | | --- | --- | | How often do US health insurers deny claims? | 15.7% of in-network claims, 83,907,852 of 533,960,787 in a single plan year, across 152 issuer-state records in 29 states, per the CMS Transparency in Coverage Public Use File. Rates vary widely by insurer; a denial rate describes the insurer, not the merits of any one claim. | | What percentage of denied health insurance claims are appealed? | Very few. Of 83,907,852 denials, 241,596 internal appeals were filed (0.288%) and only 4,918 reached independent external review, one in every 17,061 denials, 4,918 of 83,907,852. | | Do health insurance appeals actually work? | For the people who file, often. 26.8% of internal appeals are overturned nationally, and 22.2% (1,092 of 4,918; interval 22.2-23.8% for counts CMS withheld; 32.6% without SelectHealth) of independent external reviews are overturned. The external review decision is binding on the plan by law. | | How much does it cost to appeal a denied health insurance claim? | The internal appeal is free. External review is free under the HHS-administered federal process; where an insurer uses a contracted independent review organization or a state process, any fee is capped at $25 per review. | | How long do I have to appeal a health insurance denial? | Generally 180 days from the denial notice to file the internal appeal, then generally four months from the final internal denial to request external review. Your own denial letter states the deadlines that govern your plan. | | Which health insurance denials qualify for independent external review? | Denials involving medical judgment, denials on the basis that a treatment is experimental or investigational, and rescission of coverage. Purely administrative or eligibility denials may not qualify for external review but are still fully appealable internally. | ## What a reader said What surprised me was how fast everyone just moved on, the doctor suggested trying something else, no one really explained if this was something you can fight, and that was basically it We hear this most. r/HealthInsurance, “Doctor ordered an MRI, insurance said no, what do I do” , read September 3, 2026. ## Who wrote this, and when By Axion Labs · August 19, 2026, updated November 4, 2026 ## The two federal clocks The clock your letter has to describe, in actual dates Whatever else is on the page, these two dates are the page. You have 180 days from the date on your denial notice to file the internal appeal, and then 4 months from the final internal denial to ask for an independent external review. If waiting would seriously jeopardize your health you can ask for both to be expedited, decided in about 72 hours . Both timeframes are federal, not your insurer's choice, 29 CFR 2560.503-1 ( PDF ) and 45 CFR 147.136 ( PDF ), in plain English at HealthCare.gov , and your own denial letter states the ones that govern your plan. The PDFs are the same sections on govinfo.gov, which serves them without a challenge page, so an automated reader can check these two dates as easily as you can. ## How rare the second appeal is You are not alone, measured rather than said: 83,907,852 in-network claims were denied in a single plan year, and only 4,918 of them, one in 17,061, ever reached the independent review stage. Of the ones that did, 22.2% (1,092 of 4,918; interval 22.2-23.8% for counts CMS withheld; 32.6% without SelectHealth) were overturned. ## What is free here, and what the one paid thing costs Denied a claim? Insurers upheld 165,863 of the 262,982 internal appeals counted in 2024, 63.1% ( KFF ). The win is at independent external review, and the only way to arrive there is to run the internal stage on time, in the right order, with the record intact. That sequence is what the Appeal Kit is. Get my Appeal Kit, $29 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. Get my Appeal Kit, $29 Everything you need for your appeal: your two deadlines, the argument that fits your denial reason, the letters, a brief for your doctor on what the reviewer checks, 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. ## What we will not pretend What we will not pretend. 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. ## Every page on this site Home Start here Insurers By company States Denial reasons Use cases How to appeal Ranked by denial rate The external-review gap Write the letter, free Deadline calculator Self-funded plan? Prior authorization denied Medicare WISeR denial Denial code CO-50 Before you call a lawyer Attorney for a denied claim Your denial letter United Healthcare denying claims Time limits on a claim Appeal a Medicare denial About Editorial policy How we compare Privacy Terms For machines: llms.txt openapi.json changes.json the composed answer this page as markdown ## Which release these figures are Which release these figures are Every number on this page is the plan-year 2027 Transparency in Coverage file, 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 on every run and fails if CMS publishes a plan year we have not acknowledged here. Every earlier release, plan-year 2024, plan-year 2025, plan-year 2026, is kept alongside it so the record is visible rather than a single year’s snapshot; /about says what changed between them. 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. ## Where these numbers come from Where these numbers come from 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) . ## Who publishes this Denial Facts publishes federal data about health insurance claim denials. We are independent: not affiliated with, endorsed by, or acting for any insurer, government agency, or review organization. We are not a law firm, a medical provider, or an insurance producer, and nothing here is legal, medical, or insurance advice. Data: CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 claims), data.healthcare.gov — US Government public domain. Figures cover individual-market Qualified Health Plans on the federal Exchange and come from 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. See where the data comes from . ## Not advice This page presents federal statistics and a general description of appeal rights created by federal law. It is not legal, medical, or insurance advice, and no outcome is guaranteed. Your denial letter and plan documents govern your specific case. Free help is available from your state's Consumer Assistance Program and from the federal Marketplace at HealthCare.gov. ## For software and AI agents Composed answer: https://denialfacts.com/api/answer?insurer={slug}&state={XX}&reason={slug} (free, no key, attribution). Index: https://denialfacts.com/openapi.json · https://denialfacts.com/llms.txt · https://denialfacts.com/changes.json ## Sources - CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 claims), data.healthcare.gov — US Government public domain: https://data.healthcare.gov/ - 29 CFR 2560.503-1 (180 days, and your free right to the claim file): https://www.ecfr.gov/current/title-29/section-2560.503-1 - 45 CFR 147.136 (4 months, and what qualifies): https://www.ecfr.gov/current/title-45/section-147.136 - HealthCare.gov on external review: https://www.healthcare.gov/appeal-insurance-company-decision/external-review/ Cite: Axion Labs — Denial Facts, "Insurance claim denied? Your two dates, free", https://denialfacts.com/ (checked 2026-11-04). free to quote with the URL.