---
title: "Celtic NE appeal form and deadline"
url: "https://denialfacts.com/insurers/celtic-insurance-company--ne"
publisher: "Axion Labs — Denial Facts"
checked: "2026-11-04"
dataset_fixity: "sha256-cda2f9b89c8dde2a74989a35dbe7c0d08ff35dac5456484dc1c03c1b181a67b6"
---

# Celtic denied your claim in Nebraska. Here is your deadline.

Denied by Celtic in Nebraska? Your internal-appeal and external-review deadlines dated from the notice, who decides your case, and a free appeal letter.

## Figures

| Figure | Value |
| --- | --- |
| In-network denial rate | not reported |
| Claims denied | not reported |
| Plans in Nebraska | 17 |
| Internal appeals filed | not reported |
| Internal overturn rate | not reported |
| In-network claims received | not reported |
| External reviews filed | not reported |
| External overturn rate | not reported |
| National denial rate | 15.7% |

## External-review route

**State-run process.** Nebraska runs its own external review process meeting the federal standards, so an independent review there is handled through the state program rather than the federal one. 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.

## Celtic in Nebraska, at the top of the page

Nebraska

Your two dates, free

Date on your denial notice

Who pays your claims?

A job, an insurance company pays the claims

A job, my employer pays the claims itself (self-funded)

A job, I do not know which

Marketplace / individual plan I bought myself

Medicare, Medicaid, TRICARE, VA or IHS

Which state?

The reason your letter gives

I'm not sure, I'll paste the sentence later

Not medically necessary
Provider out of network
Service excluded from the plan
Experimental or investigational
Referral required
Benefit limit reached
Member not covered
Administrative reason
Other reasons

Show my two dates, free

Put in the date on your Celtic Insurance Company notice and get both federal deadlines as calendar dates.

Free, for a Celtic Insurance Company denial in Nebraska, and it runs entirely in your browser. The date, the plan type and the state you pick are never sent to us and never stored.

Celtic Insurance Company reported no usable denial count for Nebraska, so these dates are the part of this page that is certain. Across Nebraska as a whole the insurers in this file denied 16.6% of in-network claims, 325,332 of them, and 5,760 were appealed.

Or let the [$29 Appeal Kit](/appeal-kit) date each step and write the claim-file and external-review requests.

Celtic Insurance Company operates 17 plans in Nebraska.

By [Axion Labs](/about) · August 19, 2026, updated November 4, 2026

Further down this page, after the free steps: the paid next step .

Insurance got denied, what to do next?

We hear this most. [r/HealthInsurance, thread title](https://www.reddit.com/r/HealthInsurance/comments/1rdxwvi/insurance_got_denied_what_to_do_next/) , read September 3, 2026.

The number nobody else publishes, and here it is missing. CMS publishes no external-review figure for Celtic Insurance Company in Nebraska, so nobody, including the regulator, can say whether anyone ever got that far. We print no number rather than reading an absence as a zero. Nationally, 4,918 of 83,907,852 denials reached that stage, one in every 17,061, and 22.2% (1,092 of 4,918; interval 22.2-23.8% for counts CMS withheld; 32.6% without SelectHealth) of those were overturned.

The clock your letter has to describe, in actual dates

Two dates matter more than anything else on this page, and they run the same in Nebraska as everywhere else. 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](https://www.ecfr.gov/current/title-29/section-2560.503-1) ( [PDF](https://www.govinfo.gov/content/pkg/CFR-2024-title29-vol9/pdf/CFR-2024-title29-vol9-sec2560-503-1.pdf) ) and [45 CFR 147.136](https://www.ecfr.gov/current/title-45/section-147.136) ( [PDF](https://www.govinfo.gov/content/pkg/CFR-2024-title45-vol2/pdf/CFR-2024-title45-vol2-sec147-136.pdf) ), in plain English at [HealthCare.gov](https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/) , 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.

Data verified November 4, 2026 · CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 claims), data.healthcare.gov — US Government public domain

You are not alone, and here is the measured version of that sentence, for Nebraska rather than for Celtic Insurance Company, because the file left this company's rows empty: insurers in Nebraska denied 325,332 in-network claims in a single plan year, 16.6% of everything submitted, across 5 reporting insurers. How many of those came from Celtic Insurance Company is not on the record; that it happened to a great many people in Nebraska is.

- In Nebraska, Celtic Insurance Company's rate was not reported at all, and the same company files in 6 other states in this file, where the rate is not the same in any of them: 13.5% in Oklahoma, 11.5% in Tennessee, 11.4% in Kansas, down to 9.8% in Texas. Which state the plan was bought in moves the odds more than the brand on the card does.

What to do tonight

- Find the reason code on your denial letter. The federal file records no denial-reason breakdown for Celtic Insurance Company in Nebraska, so this page cannot tell you which of the 9 categories yours will be, your letter can, and it has to. Copy the exact wording and the code off it tonight: that sentence is what your appeal has to answer.

- Ask Celtic Insurance Company in Nebraska for the clinical criteria they judged you against. Under [29 CFR 2560.503-1](https://www.ecfr.gov/current/title-29/section-2560.503-1) they have to hand you the claim file and the policy they applied, free, on request, and you cannot argue with a checklist you have never read.

- Put both deadlines on your calendar before you go to bed. 180 days from the date on the letter for the internal appeal, 4 months from the final internal denial for external review. The free calculator on this page turns your date into the two calendar dates in about ten seconds. Nationally only 1 in 17,061 denials ever reaches the second stage, and none of the Celtic Insurance Company denials in Nebraska are in that count either way, the file records no figure for them. The date on your letter is the part that is certain.

None of those three steps costs anything. Anyone charging you to do them is selling you something you can do yourself in twenty minutes.

not reported

In-network denial rate

not reported

Claims denied

17

Plans in Nebraska

not reported

Internal appeals filed

not reported

Internal overturn rate

## What happened to appeals

| Stage | Filed | Overturned |
| --- | --- | --- |
| Internal appeal (to Celtic Insurance Company) | not reported | not reported |
| External review (independent) | not reported | not reported |

What that record means for your own Celtic Insurance Company letter, and by when. Celtic Insurance Company recorded no separately reported denials in Nebraska and no separately reported appeal outcome, so this page cannot tell you how its Nebraska appeals went, the Celtic Insurance Company rows in the plan-year 2027 release of the CMS Transparency in Coverage file, read November 4, 2026 ( [data.healthcare.gov](https://data.healthcare.gov/) ). Whichever way that lands, nobody files the appeal for you, and the filing runs on a clock set by which plan you hold: an employer or Marketplace plan gives you at least 180 days from the denial notice to file the internal appeal ( [29 CFR 2560.503-1(h)(3)(i)](https://www.govinfo.gov/content/pkg/CFR-2024-title29-vol9/pdf/CFR-2024-title29-vol9-sec2560-503-1.pdf) , carried onto individual-market coverage by [45 CFR 147.136(b)(3)(i)](https://www.govinfo.gov/content/pkg/CFR-2024-title45-vol2/pdf/CFR-2024-title45-vol2-sec147-136.pdf) ), while Medicare Advantage gives you 65 calendar days from the date of its notice ( [CMS](https://www.cms.gov/medicare/appeals-grievances/managed-care/reconsideration-advantage-health-plan-part-c) , [42 CFR 422.582(b)](https://www.ecfr.gov/current/title-42/section-422.582) ) and Medicaid managed care 60 calendar days from the date on the notice ( [42 CFR 438.402(c)(2)(ii)](https://www.ecfr.gov/current/title-42/section-438.402) ), both stages free, and the three steps above are the whole of what to do tonight, so take the date printed on your Celtic Insurance Company notice and file well inside whichever of those windows is yours. The free steps are above; the [$29 kit](/appeal-kit) is the same clock with the letters pre-filled for Celtic Insurance Company in Nebraska. One payment. No subscription. No cut of your claim.

## Celtic Insurance Company inside Nebraska

Your denial did not happen in a national average. It happened in a state market, alongside 4 other insurers reporting into the same federal file, and these are that market's own figures.

- Across the whole of Nebraska, the 5 insurers reporting in this file processed 1,959,381 in-network claims and denied 325,332 of them, a state denial rate of 16.6%. Celtic Insurance Company is one of those 5.

- That puts Nebraska 14th of 29 states by denial rate, 0.9 points above the 15.7% national average, before you get to what Celtic Insurance Company did inside it.

- Nebraska recorded 5,760 internal appeals against those denials: one appeal for every 56 claims the state's insurers refused.

- Independent external review was reached 12 times in the whole of Nebraska, once for every 27,111 denials, against one in 17,061 nationally. How many came from Celtic Insurance Company's denials is not on the record, that is the Nebraska figure this page names as absent at the top and sources at the foot.

- Of the Nebraska external reviews that were filed, 0 were overturned, 0%. That percentage is measured on 12 reviews, which is why the count beside it matters more than the rate does when you are deciding whether to file against Celtic Insurance Company.

- The reason Nebraska's insurers record most often is [administrative reason](/denial-reasons/administrative) , 86,491 claims, 43.1% of the state's categorized denials.

- Every Nebraska figure in this section is that state's own row in the same federal file Celtic Insurance Company's numbers above come from, [CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 claims), data.healthcare.gov — US Government public domain](https://data.healthcare.gov/) , and the full Nebraska page is free at [/states/nebraska](/states/nebraska) .

## What the file does record for Nebraska

The federal file carries no usable figures for Celtic Insurance Company in Nebraska, so nothing on this page can tell you how often this company denies or how many of its denials were appealed. What it can tell you is the market that denial happened in: Nebraska's own row, and the 4 other insurers reporting alongside Celtic Insurance Company there. Every number below is Nebraska's, not Celtic Insurance Company's, and it is labelled that way because an absent figure must never be filled in from a neighbor.

- 4 insurers in Nebraska reported a denial rate where Celtic Insurance Company reported none, from UnitedHealthcare Insurance Company at 20.2% down to Blue Cross and Blue Shield of Nebraska at 13.3%. [The whole Nebraska table is published free](/states/nebraska) .

- The largest single source of denials in Nebraska in this release was Medica Insurance Company, with 180,971, [its record is here](/insurers/medica-insurance-company--ne) . Celtic Insurance Company's own share of that total is unknown, because its rows are the ones the file left empty.

- Across the whole of Nebraska the 5 insurers reporting in this file processed 1,959,381 in-network claims and denied 325,332 of them, 16.6%. None of that total is attributable to Celtic Insurance Company: an absent row is not a zero row, and we will not add one to make the arithmetic tidy.

- The reason Nebraska's insurers recorded most often is [administrative reason](/denial-reasons/administrative) , 86,491 claims, 43.1% of the state's categorized denials against 17.2% nationally. Whether it is the reason Celtic Insurance Company recorded most often is not on the record; your own letter names yours.

- Behind it in Nebraska: [other reasons](/denial-reasons/other) at 31,802 claims, then [service excluded from the plan](/denial-reasons/service-excluded) at 23,329. Each of those pages says plainly whether external review reaches that category at all, which is the question a Celtic Insurance Company letter is going to raise next.

- Nebraska's insurers denied 325,332 in-network claims in this release, 16.6% of everything submitted, against 15.7% nationally.

- 5,760 internal appeals were filed in Nebraska against those denials, one for every 56 claims refused.

- 12 of those Nebraska denials reached independent external review, one for every 27,111, against one in 17,061 nationally.

- Your deadlines do not depend on any of it: 180 days from the date on your Celtic Insurance Company notice for the internal appeal, then four months from the final internal denial for external review, the same in Nebraska as in every other state.

- What does depend on Nebraska is who decides your case at the end, Nebraska runs its own external review process meeting the federal standards, so an insured plan there goes through the state program.

Work out your two deadlines

Put the date from your notice in and get the two calendar dates, with the days remaining.

Date on your denial notice

Which denial is this?

First denial (I have not appealed yet)

Final internal denial (my appeal was refused)

Show my deadlines

Runs entirely in your browser, the date you type is never sent to us and never stored. [Open the full calculator →](/appeal-deadline-calculator)

Or let the [$29 Appeal Kit](/appeal-kit) date each step and write the claim-file and external-review requests.

The three steps at the top of this page are the whole of what you have to do tonight. The longer
version, what the internal appeal has to contain, how the independent stage works, and how to ask
for expedited handling when waiting would seriously jeopardize your health, is
[published free here](/how-to-appeal) .

## Who appeals what at Ambetter (Centene)

Centene's Ambetter runs as state-branded plans (Superior, Sunshine, Peach State and others), the process is published per state. Its sharpest rule: claim-payment disagreements are NOT appeals at all; they go through a separate claim dispute process first. From Ambetter (Centene)'s published pages, written for health care providers (Texas plan page) and members; each is listed below with its date. It is brand-level and applies to Celtic Insurance Company in Nebraska the same as to every other Ambetter (Centene) entity in the file.

| Dispute | Route |
| --- | --- |
| Medical necessity denial | Appeal, 180 calendar days |
| Claims payment disagreement | NOT an appeal: 'the provider must follow the process for claim reconsideration or claim dispute … prior to filing a Complaint.' |

##### Operational facts from the same policy

- Medical-necessity appeal window: 180 calendar days

- Standard resolution clock: 30 calendar days

- Expedited appeal clock: 1 working day / 72 hours from complete information

- Submission (Texas plan): Complaints Department, 5900 E. Ben White Blvd., Austin, TX 78741 · Fax 1-866-683-5369 , Texas plan's address — each state plan publishes its own.

- Member appeal window: 180 calendar days, orally or in writing , Member-side confirmation of the 180-day window; also confirms the 30-day resolution clock ('shall not exceed 30 calendar days from the date Ambetter receives the appeal') and the expedited 1-working-day / 72-hour-written clock.

- Member APPEALS address differs from the complaints address: Appeals Department, 5900 E Ben White Blvd., Austin, TX 78741 · Fax 1-866-918-2266 , Same street address as the Complaints Department but a different fax: appeals go to 1-866-918-2266, grievances/complaints to 1-866-683-5369. The plan page's complaints fax is not the appeals fax.

- External review via MAXIMUS: four months from the final internal decision; standard decided ≤45 days, expedited ≤72 hours , Route: Externalappeal.com, fax 1-888-866-6190, or mail to MAXIMUS Federal Services, 3750 Monroe Avenue, Suite 705, Pittsford, NY 14534. Matches the federal 4-month right this site publishes.

Sources: [Ambetter (Centene), "Grievance and Appeals (Ambetter from Superior HealthPlan, Texas)"](https://www.ambetterhealth.com/en/tx/provider-resources/manuals-and-forms/grievance-appeals/) , quoted, not paraphrased; audience: health care providers (Texas plan page); checked 2026-11-05. [Ambetter (Centene), "Appeals and Grievances Guide (Ambetter from Superior HealthPlan, Texas — member guide, last updated December 2024)"](https://www.ambetterhealth.com/content/dam/centene/Sunshine/Ambetter/PDFs/AMB-TX-Appeals-Grievances-Guide.pdf) , quoted, not paraphrased; audience: members; checked 2026-11-05. Brand-level policy, applied here because Celtic Insurance Company is an Ambetter (Centene) entity. Your own denial letter and plan documents govern your specific case.

## Questions

##### Is Celtic Insurance Company's denial rate in Nebraska high?

Not separately reported for Celtic Insurance Company in Nebraska in this release, so this page prints no rate for it. The Nebraska market as a whole denied 16.6% of in-network claims, 325,332 of them, against 15.7% nationally, that is the state, not this insurer. A denial rate describes the insurer, not the merits of your claim.

##### How many people appealed a Celtic Insurance Company denial in Nebraska, and how many won?

Appeal volumes were not separately reported for Celtic Insurance Company in Nebraska. Across Nebraska as a whole 5,760 internal appeals were filed against 325,332 denials, one for every 56 refused, and that is the state figure, not this company's. Nationally, 26.8% of internal appeals and 22.2% of external reviews are overturned.

##### How does Celtic Insurance Company compare with other insurers in Nebraska?

Celtic Insurance Company's denial rate was not separately reported, so it cannot be ranked against the other insurers in Nebraska. The full Nebraska table is published free at /states/nebraska.

##### What does Celtic Insurance Company deny most often in Nebraska?

No denial-reason breakdown was reported for Celtic Insurance Company in Nebraska. The reason Nebraska's insurers recorded most often is administrative reason, 86,491 claims, and that is the state's mix, not this company's.

##### How long do I have to appeal a Celtic Insurance Company denial in Nebraska?

Generally 180 days from the date on the denial notice to file the internal appeal, then generally four months from the final internal denial to request independent external review. Expedited review, decided in about 72 hours, is available where delay would seriously jeopardize your health. Those timeframes are federal, so they are identical for every insurer reporting in Nebraska, Celtic Insurance Company included, what varies by state is who runs the independent review at the end. Your own denial letter states the deadlines that govern your plan; that letter is the authority.

##### Does appealing a Celtic Insurance Company denial in Nebraska cost anything?

The internal appeal to Celtic Insurance Company is free. External review is free under the HHS-administered federal process; where an issuer uses a contracted independent review organization or a state process, any fee is capped at $25 per review. Nobody in Nebraska can be charged more than that to file one.

##### Can Celtic Insurance Company ignore an external review decision in Nebraska?

No, and that is the whole point of the stage. External review decisions are binding on the plan by law. The count is the one this page names as absent for Celtic Insurance Company in Nebraska, so none is printed for it, an absent figure is not a count of none.

The federal file reports no separate figures for Celtic Insurance Company in Nebraska, so this page gives you the rights and the dates instead of a number it does not have. We are not going to tell you that you will win. This page prints the insurer's own reported numbers whichever way they fall. If what it says does not match the letter in your hand, write to us and we will correct the page.

Axion Labs · hello@getaxionlabs.com

[Get my Appeal Kit, $29](/appeal-kit)
Everything you need for your Celtic Insurance Company appeal in Nebraska: 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.

Where these numbers come from The Celtic Insurance Company figures on this page, the not reported denials, are this issuer’s own reported rows in that file. CMS did not report an external-review figure for Celtic Insurance Company in Nebraska in the plan-year 2027 release of the Transparency in Coverage file, which is why no external-review count appears above.

Counts: [CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 claims), data.healthcare.gov — US Government public domain](https://data.healthcare.gov/) . Rights and timeframes: [29 CFR 2560.503-1](https://www.ecfr.gov/current/title-29/section-2560.503-1) (180 days, and your free right to the claim file) and [45 CFR 147.136](https://www.ecfr.gov/current/title-45/section-147.136) (4 months, and what qualifies), explained at [HealthCare.gov](https://www.healthcare.gov/appeal-insurance-company-decision/external-review/) . 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)](https://www.govinfo.gov/content/pkg/CFR-2024-title29-vol9/pdf/CFR-2024-title29-vol9-sec2560-503-1.pdf) and [govinfo.gov (45 CFR 147.136)](https://www.govinfo.gov/content/pkg/CFR-2024-title45-vol2/pdf/CFR-2024-title45-vol2-sec147-136.pdf) .

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.

Problem solved: You have both dates for your Celtic Insurance Company notice, you know that Nebraska runs the external review itself, and you have the letter, free, on this screen, tonight.

## The pages that answer the next question

- [Every insurer reporting in Nebraska](/states/nebraska) , the state's own row, the 5 companies filing there, and the Nebraska insurance department's consumer number, read at source.

- [Celtic Insurance Company in Oklahoma](/insurers/celtic-insurance-company--ok) , 13.5% of in-network claims denied, 458,772 of them, the neighboring record in this file.

- [Celtic Insurance Company in Tennessee](/insurers/celtic-insurance-company--tn) , 11.5% of in-network claims denied, 1,099,147 of them, the neighboring record in this file.

- [Celtic Insurance Company in Texas](/insurers/celtic-insurance-company--tx) , 9.8% of in-network claims denied, 2,698,996 of them, the neighboring record in this file.

- [If your employer pays the claims itself](/self-funded-denial) , then Celtic Insurance Company is only administering the plan, your state's external review has no power over the denial, and the route is federal. It is the first question our own calculator asks. 5 insurers report in Nebraska; whether your plan is one of theirs at all is what that page settles.

- [If it was refused before the treatment](/prior-authorization-denied) , a prior-authorization refusal from Celtic Insurance Company runs on the same two federal clocks as a denied claim, and it can be appealed while the treatment is still ahead of you. 325,332 in-network claims were denied in Nebraska in this release; a refusal before the treatment is not counted among them and is appealed the same way.

- [Before you pay a lawyer](/before-you-call-a-lawyer) , two free appeals run before anyone bills you by the hour, and Celtic Insurance Company has to hand you the claim file for nothing under 29 CFR 2560.503-1. Free help in Nebraska starts with the state consumer line printed on that state's page.

- [All 152 insurer-state records](/insurers) , the whole table, ranked, with Celtic Insurance Company in it and the 5 that file in Nebraska beside it.

Your dates are ready. [Write the letter, free](/appeal-letter)

## 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 .

## 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, "Celtic NE appeal form and deadline", https://denialfacts.com/insurers/celtic-insurance-company--ne (checked 2026-11-04). free to quote with the URL.