Simply Healthcare Plans denied your claim in Florida. Here is your deadline.
Put in the date on your Simply Healthcare Plans, Inc. notice and get both federal deadlines as calendar dates.
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Simply Healthcare Plans, Inc. denied 18,893 of 164,215 in-network claims in Florida; every one of those denials had these same two dates on it. 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 date each step and write the claim-file and external-review requests.
Simply Healthcare Plans, Inc. denied 11.5% of in-network claims in Florida, 18,893 claims out of 164,215.
Further down this page, after the free steps: the paid next step.
Insurance got denied, what to do next?
Those 18,893 denials are 0.1% of every in-network denial recorded in Florida in this release, which makes Simply Healthcare Plans, Inc. the 10th largest source of denials of the 10 insurers reporting there. Spread across its 15 plans in the state that is about 1,260 denials per plan. 138 internal appeals were filed against those 18,893 denials. Every one of those denials carried the same two dates the tool at the top of this page works out.
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 (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.
You are not alone, and here is the measured version of that sentence: 18,893 in-network claims were denied by Simply Healthcare Plans, Inc. in Florida 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 10 insurers reporting a denial rate in Florida, Simply Healthcare Plans, Inc. is the ninth highest at 11.5%. The highest in the state is 96.2% and the lowest is 9.8%.
- That is 4.2 percentage points below the 15.7% national average across this dataset, and 2 points below the Florida average of 13.5%.
- Behind the percentage: 164,215 in-network claims were processed under 15 plans in Florida, and 18,893 of them came back denied.
- For every 10,000 claims Simply Healthcare Plans, Inc. denied, about 73 came back as an internal appeal. The other 9,927 stopped at the letter.
- Of the internal appeals it did receive, Simply Healthcare Plans, Inc. overturned 11.59%, 16 claims that started life as a no.
- Not one of those denials reached independent external review, the stage whose decision the plan is required by law to accept, and where nationally 22.2% (1,092 of 4,918; interval 22.2-23.8% for counts CMS withheld; 32.6% without SelectHealth) are overturned.
- Its most-recorded denial reason is service excluded from the plan at 42.6% of its categorized denials, against 13.4% nationally, a heavier share than the country as a whole. That is the denial mix, not an outcome rate.
- Simply Healthcare Plans, Inc. accounts for 0.1% of every in-network claim denied in Florida in this file.
- By raw volume it is the 117th largest source of denials among the 135 insurer-state records in the file that report one.
- After that, its second-most-recorded reason is other reasons, 9,354 claims, 19.9% of its categorized denials.
- Third on its own list is administrative reason, 6,694 claims, 14.3% of what Simply Healthcare Plans, Inc. categorized in Florida. Between them the top three account for 76.8% of its categorized denials.
- Where Simply Healthcare Plans, Inc. differs most from the national mix is service excluded from the plan: 42.6% of its categorized denials in Florida against 13.4% across the file.
- Read the other way round: 145,322 of those 164,215 in-network claims were paid, 88.5% of everything Simply Healthcare Plans, Inc. processed in Florida.
- Spread across the 15 plans it reports in Florida, that is about 1,260 denied claims per plan, on about 10,948 claims processed per plan.
- Its reason columns add up to 46,915 categorized rows against 18,893 denials, 248.3% 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 Florida is member not covered, 28 claims, 0.1% of what Simply Healthcare Plans, Inc. categorized there.
- Against the file as a whole, this one record is 0% of the 83,907,852 in-network claim denials reported by every issuer in it.
- Find the reason code on your denial letter. The reason Simply Healthcare Plans, Inc. records most often in Florida is service excluded from the plan, 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 Simply Healthcare Plans, Inc. in Florida for the clinical criteria they judged you against. Under 29 CFR 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. Simply Healthcare Plans, Inc. overturned 11.59% of the internal appeals it did receive, 16 claims, so the stage you are about to start is not decorative.
None of those three steps costs anything. Anyone charging you to do them is selling you something you can do yourself in twenty minutes.
How that compares
| Denial rate | Rate | Difference |
|---|---|---|
| Simply Healthcare Plans, Inc. | 11.5% | , |
| Florida average | 13.5% | -2 pts |
| National average (this dataset) | 15.7% | -4.2 pts |
Simply Healthcare Plans, 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 Simply Healthcare Plans, Inc.) | 138 | 11.59% |
| External review (independent) | 0 | not reported |
The gap nobody escalated
18,893 claims denied. 138 internal appeals filed. None reached independent external review. Nationally 22.2% (1,092 of 4,918; interval 22.2-23.8% for counts CMS withheld; 32.6% without SelectHealth) of external reviews are overturned and the decision binds the plan.
That is arithmetic from the reported figures, not a prediction: nobody can say what those specific denials would have done at review, because they never got there. What the numbers do establish is that the binding stage was almost entirely unused here.
What that record means for your own Simply Healthcare Plans, Inc. letter, and by when. Simply Healthcare Plans, Inc. overturned 11.59% of the 138 internal appeals its Florida members filed against 18,893 denials, and not one of those Florida denials went on to the independent stage whose decision binds the plan, Simply Healthcare Plans, Inc.'s own rows in the plan-year 2027 release of the CMS Transparency in Coverage file, read November 4, 2026 (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), carried onto individual-market coverage by 45 CFR 147.136(b)(3)(i)), while Medicare Advantage gives you 65 calendar days from the date of its notice (CMS, 42 CFR 422.582(b)) and Medicaid managed care 60 calendar days from the date on the notice (42 CFR 438.402(c)(2)(ii)), both stages free, and the three steps above are the whole of what to do tonight, so take the date printed on your Simply Healthcare Plans, Inc. notice and file well inside whichever of those windows is yours. The free steps are above; the $29 kit is the same clock with the letters pre-filled for Simply Healthcare Plans, Inc. in Florida. One payment. No subscription. No cut of your claim.
Simply Healthcare Plans, Inc. 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%. Simply Healthcare Plans, Inc. 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 Simply Healthcare Plans, Inc. did inside it.
- Florida recorded 17,829 internal appeals against those denials: one appeal for every 982 claims the state's insurers refused. Simply Healthcare Plans, Inc.'s own ratio is one for every 137.
- Independent external review was reached 269 times in the whole of Florida, once for every 65,113 denials, against one in 17,061 nationally. None of them came from Simply Healthcare Plans, Inc.'s denials.
- 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 Simply Healthcare Plans, Inc..
- The reason Florida's insurers record most often is other reasons, 5,343,365 claims, 33.3% of the state's categorized denials. Simply Healthcare Plans, Inc. records service excluded from the plan most often instead, which is the argument your letter will need to answer.
- The other insurers a Florida reader could have bought from run from 96.2% (Capital Health Plan) to 9.8% (Centene Venture Company Florida). Simply Healthcare Plans, Inc. at 11.5% sits between the two.
- Put the two together and Simply Healthcare Plans, Inc. is responsible for 0.1% of every in-network claim denied in Florida in this release, from 0.1% of the claims the state's insurers processed.
- Every Florida figure in this section is that state's own row in the same federal file Simply Healthcare Plans, Inc.'s numbers above come from, CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 claims), data.healthcare.gov — US Government public domain, and the full Florida page is free at /states/florida.
What Simply Healthcare Plans, Inc. denies most
The most common denial reason recorded for Simply Healthcare Plans, Inc. plans in Florida is service excluded from the plan. How that denial is beaten →
| Denial reason | Claims | Share | National share |
|---|---|---|---|
| Service excluded from the plan | 20,002 | 42.6% | 13.4% |
| Other reasons | 9,354 | 19.9% | 32.4% |
| Administrative reason | 6,694 | 14.3% | 17.2% |
| Referral required | 5,957 | 12.7% | 9.6% |
| Provider out of network | 3,908 | 8.3% | 9% |
| Not medically necessary | 934 | 2% | 5.5% |
| Benefit limit reached | 38 | 0.1% | 4.9% |
| Member not covered | 28 | 0.1% | 7.9% |
The last column is each reason's share of all categorized denials nationally, so you can see where Simply Healthcare Plans, Inc.'s mix in Florida 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.
Put the date from your notice in and get the two calendar dates, with the days remaining.
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Or let the $29 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. For what it is worth on this page specifically: Simply Healthcare Plans, Inc. overturned 11.59% of the internal appeals it received.
Questions
Is Simply Healthcare Plans, Inc.'s denial rate in Florida high?
11.5% 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 a Simply Healthcare Plans, Inc. denial in Florida, and how many won?
138 internal appeals were filed against 18,893 denials, and 11.59% of them were overturned (16 claims). Not one went on to independent external review, the stage whose decision is binding on the plan.
How does Simply Healthcare Plans, Inc. compare with other insurers in Florida?
Of the 10 insurers in Florida with a reported denial rate, Simply Healthcare Plans, Inc. ranks 9 highest at 11.5%. The highest in Florida is Capital Health Plan at 96.2%; the lowest is Centene Venture Company Florida at 9.8%.
What does Simply Healthcare Plans, Inc. deny most often in Florida?
Service excluded from the plan, 20,002 claims, 42.6% of this issuer's categorized denials, against 13.4% nationally. This is the denial-reason mix; the federal file does not report overturn rates by reason.
How long do I have to appeal a Simply Healthcare Plans, Inc. 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, Simply Healthcare Plans, 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 a Simply Healthcare Plans, Inc. denial in Florida cost anything?
The internal appeal to Simply Healthcare Plans, 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 Florida can be charged more than that to file one.
Can Simply Healthcare Plans, Inc. 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, which is what makes the zero external reviews recorded against 18,893 Simply Healthcare Plans, Inc. denials in Florida the striking number on this page.
The line on this page we would read twice is the one that says not one of Simply Healthcare Plans, Inc.'s 18,893 denials in Florida reached independent review. 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.comEverything you need for your Simply Healthcare Plans, Inc. 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.
The Simply Healthcare Plans, Inc. figures on this page, the 11.5% denial rate, the 18,893 denials and the 0 external reviews, are this issuer’s own reported rows in that file.
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).