--- title: "Oscar Health Maintenance Organization of Florida appeal" url: "https://denialfacts.com/insurers/oscar-health-maintenance-organization-of-florida--fl" publisher: "Axion Labs — Denial Facts" checked: "2026-11-04" dataset_fixity: "sha256-cda2f9b89c8dde2a74989a35dbe7c0d08ff35dac5456484dc1c03c1b181a67b6" --- # Oscar Health Maintenance Organization of Florida denied your claim. Here is your deadline. Oscar Health Maintenance Organization of Florida: how to appeal a denial, and the two federal deadlines dated from your notice. ## Figures | Figure | Value | | --- | --- | | In-network denial rate | not reported | | Claims denied | not reported | | Plans in Florida | 56 | | 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 **Federal process.** CMS lists Florida among the states without an external review process meeting the federal standards. Insurers there must use either the HHS-administered federal process or an independent review organization under contract. 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. ## Oscar Health Maintenance Organization of Florida in Florida, at the top of the page Florida 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 Oscar Health Maintenance Organization of Florida notice and get both federal deadlines as calendar dates. Free, for an Oscar Health Maintenance Organization of Florida denial in Florida, 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. Oscar Health Maintenance Organization of Florida reported no usable denial count for Florida, so these dates are the part of this page that is certain. Across Florida as a whole the insurers in this file denied 13.5% of in-network claims, 17,515,496 of them, and 17,829 were appealed. Or let the [$29 Appeal Kit](/appeal-kit) date each step and write the claim-file and external-review requests. Oscar Health Maintenance Organization of Florida operates 56 plans in Florida. 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 Oscar Health Maintenance Organization of Florida in Florida, 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 Florida 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. Notice for Oscar Health Maintenance Organization of Florida in Florida, there is a deadline in this one. CMS says the HHS-Administered Federal External Review Process reopened on July 31, 2026. If your plan uses that process and you could not file between July 1, 2026 and August 3, 2026, CMS says you may be eligible for an extension and have until October 2, 2026 to request external review. If you filed before July 1, 2026 you do not need to resubmit; if you already have a final decision through the federal process, the extension does not apply to you. HealthCare.gov names one group this state-by-state page cannot show you: it says the extension may reach you if you have a state or local government plan in any state , not only in the states whose insurers use the federal process. Both pages were read at source on September 5, 2026 and this is what they said that day, [the CCIIO external appeals page](https://www.cms.gov/CCIIO/Resources/Files/external_appeals) and [HealthCare.gov on external review](https://www.healthcare.gov/appeal-insurance-company-decision/external-review/) . Read them again before you rely on this: it is a live deadline and it has moved once already. Florida is one of the states CMS lists as using the federal process, so this applies to an insured plan bought there. If your plan uses a contracted independent review organization instead, none of this affects you. 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 Florida rather than for Oscar Health Maintenance Organization of Florida, because the file left this company's rows empty: insurers in Florida denied 17,515,496 in-network claims in a single plan year, 13.5% of everything submitted, across 12 reporting insurers. How many of those came from Oscar Health Maintenance Organization of Florida is not on the record; that it happened to a great many people in Florida is. What to do tonight - Find the reason code on your denial letter. The federal file records no denial-reason breakdown for Oscar Health Maintenance Organization of Florida in Florida, 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 Oscar Health Maintenance Organization of Florida in Florida 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 Oscar Health Maintenance Organization of Florida denials in Florida 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 56 Plans in Florida not reported Internal appeals filed not reported Internal overturn rate ## What happened to appeals | Stage | Filed | Overturned | | --- | --- | --- | | Internal appeal (to Oscar Health Maintenance Organization of Florida) | not reported | not reported | | External review (independent) | not reported | not reported | What that record means for your own Oscar Health Maintenance Organization of Florida letter, and by when. Oscar Health Maintenance Organization of Florida recorded no separately reported denials in Florida and no separately reported appeal outcome, so this page cannot tell you how its Florida appeals went, the Oscar Health Maintenance Organization of Florida 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 Oscar Health Maintenance Organization of Florida 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 Oscar Health Maintenance Organization of Florida in Florida. One payment. No subscription. No cut of your claim. ## Oscar Health Maintenance Organization of Florida inside Florida Your denial did not happen in a national average. It happened in a state market, alongside 11 other insurers reporting into the same federal file, and these are that market's own figures. - Across the whole of Florida, the 12 insurers reporting in this file processed 129,636,840 in-network claims and denied 17,515,496 of them, a state denial rate of 13.5%. Oscar Health Maintenance Organization of Florida is one of those 12. - That puts Florida 20th of 29 states by denial rate, 2.2 points below the 15.7% national average, before you get to what Oscar Health Maintenance Organization of Florida did inside it. - Florida recorded 17,829 internal appeals against those denials: one appeal for every 982 claims the state's insurers refused. - Independent external review was reached 269 times in the whole of Florida, once for every 65,113 denials, against one in 17,061 nationally. How many came from Oscar Health Maintenance Organization of Florida's denials is not on the record, that is the Florida figure this page names as absent at the top and sources at the foot. - Of the Florida external reviews that were filed, 94 were overturned, 34.9%. That percentage is measured on 269 reviews, which is why the count beside it matters more than the rate does when you are deciding whether to file against Oscar Health Maintenance Organization of Florida. - The reason Florida's insurers record most often is [other reasons](/denial-reasons/other) , 5,343,365 claims, 33.3% of the state's categorized denials. - Every Florida figure in this section is that state's own row in the same federal file Oscar Health Maintenance Organization of Florida'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 Florida page is free at [/states/florida](/states/florida) . ## What the file does record for Florida The federal file carries no usable figures for Oscar Health Maintenance Organization of Florida in Florida, 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: Florida's own row, and the 11 other insurers reporting alongside Oscar Health Maintenance Organization of Florida there. Every number below is Florida's, not Oscar Health Maintenance Organization of Florida's, and it is labelled that way because an absent figure must never be filled in from a neighbor. - 10 insurers in Florida reported a denial rate where Oscar Health Maintenance Organization of Florida reported none, from Capital Health Plan at 96.2% down to Centene Venture Company Florida at 9.8%. [The whole Florida table is published free](/states/florida) . - The largest single source of denials in Florida in this release was Health Options, Inc., with 6,445,991, [its record is here](/insurers/health-options-inc--fl) . Oscar Health Maintenance Organization of Florida's own share of that total is unknown, because its rows are the ones the file left empty. - Across the whole of Florida the 12 insurers reporting in this file processed 129,636,840 in-network claims and denied 17,515,496 of them, 13.5%. None of that total is attributable to Oscar Health Maintenance Organization of Florida: an absent row is not a zero row, and we will not add one to make the arithmetic tidy. - The reason Florida's insurers recorded most often is [other reasons](/denial-reasons/other) , 5,343,365 claims, 33.3% of the state's categorized denials against 32.4% nationally. Whether it is the reason Oscar Health Maintenance Organization of Florida recorded most often is not on the record; your own letter names yours. - Behind it in Florida: [administrative reason](/denial-reasons/administrative) at 3,207,510 claims, then [service excluded from the plan](/denial-reasons/service-excluded) at 1,677,180. Each of those pages says plainly whether external review reaches that category at all, which is the question a Oscar Health Maintenance Organization of Florida letter is going to raise next. - Florida's insurers denied 17,515,496 in-network claims in this release, 13.5% of everything submitted, against 15.7% nationally. - 17,829 internal appeals were filed in Florida against those denials, one for every 982 claims refused. - 269 of those Florida denials reached independent external review, one for every 65,113, against one in 17,061 nationally. - Your deadlines do not depend on any of it: 180 days from the date on your Oscar Health Maintenance Organization of Florida notice for the internal appeal, then four months from the final internal denial for external review, the same in Florida as in every other state. - What does depend on Florida is who decides your case at the end, CMS lists Florida among the states without a process meeting the federal standards, so an insured plan there goes to the federal process or to an independent review organization the insurer contracts with. 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 Oscar Health Maintenance Organization of Florida's denial rate in Florida high? Not separately reported for Oscar Health Maintenance Organization of Florida in Florida in this release, so this page prints no rate for it. The Florida market as a whole denied 13.5% of in-network claims, 17,515,496 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 an Oscar Health Maintenance Organization of Florida denial in Florida, and how many won? Appeal volumes were not separately reported for Oscar Health Maintenance Organization of Florida in Florida. Across Florida as a whole 17,829 internal appeals were filed against 17,515,496 denials, one for every 982 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 Oscar Health Maintenance Organization of Florida compare with other insurers in Florida? Oscar Health Maintenance Organization of Florida's denial rate was not separately reported, so it cannot be ranked against the other insurers in Florida. The full Florida table is published free at /states/florida. ##### What does Oscar Health Maintenance Organization of Florida deny most often in Florida? No denial-reason breakdown was reported for Oscar Health Maintenance Organization of Florida in Florida. The reason Florida's insurers recorded most often is other reasons, 5,343,365 claims, and that is the state's mix, not this company's. ##### How long do I have to appeal an Oscar Health Maintenance Organization of Florida denial in Florida? 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 Florida, Oscar Health Maintenance Organization of Florida 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 Oscar Health Maintenance Organization of Florida denial in Florida cost anything? The internal appeal to Oscar Health Maintenance Organization of Florida 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 Florida can be charged more than that to file one. ##### Can Oscar Health Maintenance Organization of Florida ignore an external review decision in Florida? 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 Oscar Health Maintenance Organization of Florida in Florida, so none is printed for it, an absent figure is not a count of none. The federal file reports no separate figures for Oscar Health Maintenance Organization of Florida in Florida, 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 Oscar Health Maintenance Organization of Florida appeal in Florida: 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 Oscar Health Maintenance Organization of Florida 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 Oscar Health Maintenance Organization of Florida in Florida 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 Oscar Health Maintenance Organization of Florida notice, you know that an insured plan in Florida goes to the federal process, and you have the letter, free, on this screen, tonight. ## The pages that answer the next question - [Every insurer reporting in Florida](/states/florida) , the state's own row, the 12 companies filing there, and the Florida insurance department's consumer number, read at source. - [Oscar Health denial rate](/company/oscar) , Oscar Health Maintenance Organization of Florida is the Florida one; the brand's national rate is 16.8% across 12,378,781 claims in 15 states, and it is not the same in any two of them. - [Oscar Health Plan, Inc. in Arizona](/insurers/oscar-health-plan-inc--az) , 17.8% of in-network claims denied, 69,003 of them, the neighboring record in this file. - [Oscar Health Plan, Inc. in Mississippi](/insurers/oscar-health-plan-inc--ms) , the neighboring record in this file; CMS reported no usable denial count for it. - [Oscar Health Plan, Inc. in South Carolina](/insurers/oscar-health-plan-inc--sc) , the neighboring record in this file; CMS reported no usable denial count for it. - [If your employer pays the claims itself](/self-funded-denial) , then Oscar Health Maintenance Organization of Florida 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. 12 insurers report in Florida; 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 Oscar Health Maintenance Organization of Florida runs on the same two federal clocks as a denied claim, and it can be appealed while the treatment is still ahead of you. 17,515,496 in-network claims were denied in Florida 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 Oscar Health Maintenance Organization of Florida has to hand you the claim file for nothing under 29 CFR 2560.503-1. Free help in Florida starts with the state consumer line printed on that state's page. - [All 152 insurer-state records](/insurers) , the whole table, ranked, with Oscar Health Maintenance Organization of Florida in it and the 12 that file in Florida 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/ - CCIIO state external review table (read August 3, 2026): https://www.cms.gov/CCIIO/Resources/Files/external_appeals - 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, "Oscar Health Maintenance Organization of Florida appeal", https://denialfacts.com/insurers/oscar-health-maintenance-organization-of-florida--fl (checked 2026-11-04). free to quote with the URL.