---
title: "Iowa Total Care appeal form and deadline"
url: "https://denialfacts.com/insurers/iowa-total-care-inc--ia"
publisher: "Axion Labs — Denial Facts"
checked: "2026-11-04"
dataset_fixity: "sha256-cda2f9b89c8dde2a74989a35dbe7c0d08ff35dac5456484dc1c03c1b181a67b6"
---

# Iowa Total Care denied your claim. Here is your deadline.

Denied by Iowa Total Care? Your two federal appeal deadlines dated from your notice, a free letter, and its 14.2% denial rate in the federal file.

## Figures

| Figure | Value |
| --- | --- |
| In-network denial rate | 14.2% |
| Claims denied | 44,021 |
| Plans in Iowa | 17 |
| Internal appeals filed | not reported |
| Internal overturn rate | not reported |
| In-network claims received | 309,045 |
| External reviews filed | not reported |
| External overturn rate | not reported |
| National denial rate | 15.7% |

## External-review route

**State-run process.** Iowa 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.

## Denials by reason

| Reason | Claims | Share of this insurer's categorized denials |
| --- | --- | --- |
| Administrative reason | 16,847 | 20.4% |
| Service excluded from the plan | 13,990 | 17% |
| Referral required | 13,085 | 15.9% |
| Not medically necessary | 12,059 | 14.6% |
| Other reasons | 9,068 | 11% |
| Provider out of network | 6,416 | 7.8% |
| Benefit limit reached | 5,609 | 6.8% |
| Member not covered | 5,419 | 6.6% |

## Iowa Total Care in Iowa, at the top of the page

Iowa

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 Iowa Total Care, Inc. notice and get both federal deadlines as calendar dates.

Free, for an Iowa Total Care, Inc. denial in Iowa, 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.

Iowa Total Care, Inc. denied 44,021 of 309,045 in-network claims in Iowa; every one of those denials had these same two dates on it. Across Iowa as a whole the insurers in this file denied 17.7% of in-network claims, 915,031 of them, and 9,174 were appealed.

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

Iowa Total Care, Inc. denied 14.2% of in-network claims in Iowa, 44,021 claims out of 309,045.

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 Iowa Total Care, Inc. in Iowa, 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.

Those 44,021 denials are 4.8% of every in-network denial recorded in Iowa in this release, which makes Iowa Total Care, Inc. the 3rd largest source of denials of the 4 insurers reporting there. Spread across its 17 plans in the state that is about 2,589 denials per plan. Every one of those denials carried the same two dates the tool at the top of this page works out.

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 Iowa 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: 44,021 in-network claims were denied by Iowa Total Care, Inc. in Iowa in a single plan year. A denial rate is a fact about an insurer's book of business. It is not a judgment about you, and it is not the last word on your claim.

- Of the 4 insurers reporting a denial rate in Iowa, Iowa Total Care, Inc. is the fourth highest at 14.2%. The highest in the state is 18% and the lowest is 14.2%.

- That is 1.5 percentage points below the 15.7% national average across this dataset, and 3.5 points below the Iowa average of 17.7%.

- Behind the percentage: 309,045 in-network claims were processed under 17 plans in Iowa, and 44,021 of them came back denied.

- Its most-recorded denial reason is administrative reason at 20.4% of its categorized denials, against 17.2% nationally, a heavier share than the country as a whole. That is the denial mix, not an outcome rate.

- Iowa Total Care, Inc. accounts for 4.8% of every in-network claim denied in Iowa in this file.

- By raw volume it is the 103th largest source of denials among the 135 insurer-state records in the file that report one.

- After that, its second-most-recorded reason is [service excluded from the plan](/denial-reasons/service-excluded) , 13,990 claims, 17% of its categorized denials.

- Third on its own list is [referral required](/denial-reasons/referral-required) , 13,085 claims, 15.9% of what Iowa Total Care, Inc. categorized in Iowa. Between them the top three account for 53.2% of its categorized denials.

- Where Iowa Total Care, Inc. differs most from the national mix is [not medically necessary](/denial-reasons/not-medically-necessary) : 14.6% of its categorized denials in Iowa against 5.5% across the file.

- Read the other way round: 265,024 of those 309,045 in-network claims were paid, 85.8% of everything Iowa Total Care, Inc. processed in Iowa.

- Spread across the 17 plans it reports in Iowa, that is about 2,589 denied claims per plan, on about 18,179 claims processed per plan.

- Its reason columns add up to 82,493 categorized rows against 44,021 denials, 187.4% of them, and every reason share on this page is a share of that first figure rather than of the second.

- Its smallest recorded category in Iowa is [member not covered](/denial-reasons/member-not-covered) , 5,419 claims, 6.6% of what Iowa Total Care, Inc. categorized there.

- Against the file as a whole, this one record is 0.1% of the 83,907,852 in-network claim denials reported by every issuer in it.

What to do tonight

- Find the reason code on your denial letter. The reason Iowa Total Care, Inc. records most often in Iowa is administrative reason , but yours may be one of the other 8, copy the exact wording and code off your own letter tonight, because that sentence is what your appeal has to answer.

- Ask Iowa Total Care, Inc. in Iowa 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. 44,021 claims were denied here in a single year and the escalation count for Iowa Total Care, Inc. in Iowa is the figure the top of this page records as absent, so how many were escalated is not on the record; the deadline is what decides whether anyone reads the argument.

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

14.2%

In-network denial rate

44,021

Claims denied

17

Plans in Iowa

not reported

Internal appeals filed

not reported

Internal overturn rate

## How that compares

| Denial rate | Rate | Difference |
| --- | --- | --- |
| Iowa Total Care, Inc. | 14.2% | , |
| Iowa average | 17.7% | -3.5 pts |
| National average (this dataset) | 15.7% | -1.5 pts |

Iowa Total Care, Inc. sits at or below the national average across this dataset. A denial rate is a property of the insurer's book of business, coding practice, plan design, the population it covers, not evidence about the merits of any one claim, including yours.

## What happened to appeals

| Stage | Filed | Overturned |
| --- | --- | --- |
| Internal appeal (to Iowa Total Care, Inc.) | not reported | not reported |
| External review (independent) | not reported | not reported |

Read the table for what it is: the external-review row above shows a dash, which means not reported and not zero, the Iowa absence this page states once at the top for Iowa Total Care, Inc. and sources once at the foot. External review is free to you and the insurer must follow the decision, whatever this file does or does not record about it.

What that record means for your own Iowa Total Care, Inc. letter, and by when. Iowa Total Care, Inc. recorded 44,021 denials in Iowa and no separately reported appeal outcome, so this page cannot tell you how its Iowa appeals went, the Iowa Total Care, Inc. 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 Iowa Total Care, Inc. 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 Iowa Total Care, Inc. in Iowa. One payment. No subscription. No cut of your claim.

## Iowa Total Care, Inc. inside Iowa

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 Iowa, the 5 insurers reporting in this file processed 5,158,977 in-network claims and denied 915,031 of them, a state denial rate of 17.7%. Iowa Total Care, Inc. is one of those 5.

- That puts Iowa eighth of 29 states by denial rate, 2 points above the 15.7% national average, before you get to what Iowa Total Care, Inc. did inside it.

- Iowa recorded 9,174 internal appeals against those denials: one appeal for every 100 claims the state's insurers refused.

- Independent external review was reached 37 times in the whole of Iowa, once for every 24,731 denials, against one in 17,061 nationally. How many came from Iowa Total Care, Inc.'s denials is not on the record, that is the Iowa figure this page names as absent at the top and sources at the foot.

- Of the Iowa external reviews that were filed, 13 were overturned, 35.1%. That percentage is measured on 37 reviews, which is why the count beside it matters more than the rate does when you are deciding whether to file against Iowa Total Care, Inc..

- The reason Iowa's insurers record most often is [other reasons](/denial-reasons/other) , 541,040 claims, 47.3% of the state's categorized denials. Iowa Total Care, Inc. records administrative reason most often instead, which is the argument your letter will need to answer.

- The other insurers an Iowa reader could have bought from run from 18% ( [Wellmark Health Plan of Iowa, Inc.](/insurers/wellmark-health-plan-of-iowa-inc--ia) ) to 16% ( [UnitedHealthcare Plan of the River Valley, Inc.](/insurers/unitedhealthcare-plan-of-the-river-valley-inc--ia) ). Iowa Total Care, Inc. at 14.2% sits below all of them.

- Put the two together and Iowa Total Care, Inc. is responsible for 4.8% of every in-network claim denied in Iowa in this release, from 6% of the claims the state's insurers processed.

- Every Iowa figure in this section is that state's own row in the same federal file Iowa Total Care, Inc.'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 Iowa page is free at [/states/iowa](/states/iowa) .

## What Iowa Total Care, Inc. denies most

The most common denial reason recorded for Iowa Total Care, Inc. plans in Iowa is administrative reason . [How that denial is beaten →](/denial-reasons/administrative)

| Denial reason | Claims | Share | National share |
| --- | --- | --- | --- |
| Administrative reason | 16,847 | 20.4% | 17.2% |
| Service excluded from the plan | 13,990 | 17% | 13.4% |
| Referral required | 13,085 | 15.9% | 9.6% |
| Not medically necessary | 12,059 | 14.6% | 5.5% |
| Other reasons | 9,068 | 11% | 32.4% |
| Provider out of network | 6,416 | 7.8% | 9% |
| Benefit limit reached | 5,609 | 6.8% | 4.9% |
| Member not covered | 5,419 | 6.6% | 7.9% |

The last column is each reason's share of all categorized denials nationally, so you can see where Iowa Total Care, Inc.'s mix in Iowa differs from everyone else's. This is denial mix , not overturn rate by reason , the federal file does not report appeal outcomes broken down by denial reason, and we do not imply otherwise.

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) .

## Questions

##### Is Iowa Total Care, Inc.'s denial rate in Iowa high?

14.2% against a national average of 15.7% across the plans in this dataset. It is at or below average. A denial rate describes the insurer, not the merits of your claim.

##### How many people appealed an Iowa Total Care, Inc. denial in Iowa, and how many won?

Appeal volumes were not separately reported for Iowa Total Care, Inc. in Iowa. Across Iowa as a whole 9,174 internal appeals were filed against 915,031 denials, one for every 100 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 Iowa Total Care, Inc. compare with other insurers in Iowa?

Of the 4 insurers in Iowa with a reported denial rate, Iowa Total Care, Inc. ranks 4 highest at 14.2%. The highest in Iowa is Wellmark Health Plan of Iowa, Inc. at 18%; the lowest is Iowa Total Care, Inc. at 14.2%.

##### What does Iowa Total Care, Inc. deny most often in Iowa?

Administrative reason, 16,847 claims, 20.4% of this issuer's categorized denials, against 17.2% nationally. This is the denial-reason mix; the federal file does not report overturn rates by reason.

##### How long do I have to appeal an Iowa Total Care, Inc. denial in Iowa?

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 Iowa, Iowa Total Care, Inc. 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 an Iowa Total Care, Inc. denial in Iowa cost anything?

The internal appeal to Iowa Total Care, Inc. 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 Iowa can be charged more than that to file one.

##### Can Iowa Total Care, Inc. ignore an external review decision in Iowa?

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 Iowa Total Care, Inc. in Iowa, so none is printed for it, an absent figure is not a count of none.

Iowa Total Care, Inc. sits at 14.2% in Iowa against 15.7% nationally, and that is the whole of what this page can honestly tell you about your own claim. 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 Iowa Total Care, Inc. appeal in Iowa: 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 Iowa Total Care, Inc. figures on this page, the 14.2% denial rate, the 44,021 denials, are this issuer’s own reported rows in that file. CMS did not report an external-review figure for Iowa Total Care, Inc. in Iowa 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 Iowa Total Care, Inc. notice, you know that Iowa 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 Iowa](/states/iowa) , the state's own row, the 5 companies filing there, and the Iowa insurance department's consumer number, read at source.

- [Kaiser Foundation Health Plan, Inc. in Hawaii](/insurers/kaiser-foundation-health-plan-inc--hi) , the neighboring record in this file; CMS reported no usable denial count for it.

- [Louisiana Health Service & Indemnity Company in Louisiana](/insurers/louisiana-health-service-indemnity-company--la) , 18% of in-network claims denied, 186,882 of them, the neighboring record in this file.

- [Matthew Thornton Health Plan, Inc. in New Hampshire](/insurers/matthew-thornton-health-plan-inc--nh) , 6.7% of in-network claims denied, 123,552 of them, the neighboring record in this file.

- [If your employer pays the claims itself](/self-funded-denial) , then Iowa Total Care, Inc. 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 Iowa; 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 Iowa Total Care, Inc. runs on the same two federal clocks as a denied claim, and it can be appealed while the treatment is still ahead of you. 915,031 in-network claims were denied in Iowa 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 Iowa Total Care, Inc. has to hand you the claim file for nothing under 29 CFR 2560.503-1. Free help in Iowa starts with the state consumer line printed on that state's page.

- [All 152 insurer-state records](/insurers) , the whole table, ranked, with Iowa Total Care, Inc. in it and the 5 that file in Iowa 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, "Iowa Total Care appeal form and deadline", https://denialfacts.com/insurers/iowa-total-care-inc--ia (checked 2026-11-04). free to quote with the URL.