Sunshine State denied your claim in Florida. Here is your deadline.
Put in the date on your Sunshine State Health Plan notice and get both federal deadlines as calendar dates.
Free, for a Sunshine State Health Plan 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.
Sunshine State Health Plan denied 256,694 of 1,271,365 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 22.2% of in-network claims, 18,256,139 of them, and 12,952 were appealed.
Sunshine State Health Plan denied 20.2% of in-network claims in Florida, 256,694 claims out of 1,271,365.
Insurance got denied, what to do next?
Those 256,694 denials are 1.4% of every in-network denial recorded in Florida in this release, which makes Sunshine State Health Plan the 8th largest source of denials of the 11 insurers reporting there. Spread across its 7 plans in the state that is about 36,671 denials per plan. 437 internal appeals were filed against those 256,694 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: 256,694 in-network claims were denied by Sunshine State Health Plan 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 11 insurers reporting a denial rate in Florida, Sunshine State Health Plan is the sixth highest at 20.2%. The highest in the state is 27.3% and the lowest is 6.5%.
- That is 1.5 percentage points above the 18.7% national average across this dataset, and 2 points below the Florida average of 22.2%.
- Behind the percentage: 1,271,365 in-network claims were processed under 7 plans in Florida, and 256,694 of them came back denied.
- For every 10,000 claims Sunshine State Health Plan denied, about 17 came back as an internal appeal. The other 9,983 stopped at the letter.
- Its most-recorded denial reason is referral required at 24.6% of its categorized denials, against 8.4% nationally, a heavier share than the country as a whole. That is the denial mix, not an outcome rate.
- Sunshine State Health Plan accounts for 1.4% of every in-network claim denied in Florida in this file.
- By raw volume it is the 57th largest source of denials among the 158 insurer-state records in the file that report one.
- After that, its second-most-recorded reason is administrative reason, 53,474 claims, 18.1% of its categorized denials.
- Third on its own list is member not covered, 40,874 claims, 13.9% of what Sunshine State Health Plan categorized in Florida. Between them the top three account for 56.6% of its categorized denials.
- Where Sunshine State Health Plan differs most from the national mix is referral required: 24.6% of its categorized denials in Florida against 8.4% across the file.
- Read the other way round: 1,014,671 of those 1,271,365 in-network claims were paid, 79.8% of everything Sunshine State Health Plan processed in Florida.
- Spread across the 7 plans it reports in Florida, that is about 36,671 denied claims per plan, on about 181,624 claims processed per plan.
- Its reason columns add up to 294,744 categorized rows against 256,694 denials, 114.8% 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 benefit limit reached, 15,579 claims, 5.3% of what Sunshine State Health Plan categorized there.
- Against the file as a whole, this one record is 0.3% of the 84,502,749 in-network claim denials reported by every issuer in it.
- Find the reason code on your denial letter. The reason Sunshine State Health Plan records most often in Florida is referral required, 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 Sunshine State Health Plan 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. 256,694 claims were denied here in a single year and the escalation count for Sunshine State Health Plan in Florida 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.
How that compares
| Denial rate | Rate | Difference |
|---|---|---|
| Sunshine State Health Plan | 20.2% | , |
| Florida average | 22.2% | -2 pts |
| National average (this dataset) | 18.7% | +1.5 pts |
Sunshine State Health Plan denies 1.5 percentage points more of its in-network claims than 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 Sunshine State Health Plan) | 437 | not reported |
| External review (independent) | not reported | not reported |
What that record means for your own Sunshine State Health Plan letter, and by when. Sunshine State Health Plan recorded 256,694 denials in Florida and no separately reported appeal outcome, so this page cannot tell you how its Florida appeals went, the Sunshine State Health Plan rows in the plan-year 2026 release of the CMS Transparency in Coverage file, read September 5, 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 60 calendar days after you receive its notice (42 CFR 422.582(b)) and Medicaid managed care the same 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 Sunshine State Health Plan 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 Sunshine State Health Plan in Florida. One payment. No subscription. No cut of your claim.
Sunshine State Health Plan inside Florida
Your denial did not happen in a national average. It happened in a state market, alongside 15 other insurers reporting into the same federal file, and these are that market's own figures.
- Across the whole of Florida, the 16 insurers reporting in this file processed 82,397,280 in-network claims and denied 18,256,139 of them, a state denial rate of 22.2%. Sunshine State Health Plan is one of those 16.
- That puts Florida third of 30 states by denial rate, 3.5 points above the 18.7% national average, before you get to what Sunshine State Health Plan did inside it.
- Florida recorded 12,952 internal appeals against those denials: one appeal for every 1,410 claims the state's insurers refused. Sunshine State Health Plan's own ratio is one for every 587.
- Independent external review was reached 429 times in the whole of Florida, once for every 42,555 denials, against one in 14,369 nationally. How many came from Sunshine State Health Plan'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, 174 were overturned, 40.6%. That percentage is measured on 429 reviews, which is why the count beside it matters more than the rate does when you are deciding whether to file against Sunshine State Health Plan.
- The reason Florida's insurers record most often is other reasons, 7,129,622 claims, 42.7% of the state's categorized denials. Sunshine State Health Plan records referral required 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 27.3% (AvMed, Inc.) to 6.5% (Capital Health Plan). Sunshine State Health Plan at 20.2% sits between the two.
- Put the two together and Sunshine State Health Plan is responsible for 1.4% of every in-network claim denied in Florida in this release, from 1.5% 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 Sunshine State Health Plan's numbers above come from, CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 claims), data.healthcare.gov — US Government public domain, and the full Florida page is free at /states/florida.
What Sunshine State Health Plan denies most
The most common denial reason recorded for Sunshine State Health Plan plans in Florida is referral required. How that denial is beaten →
| Denial reason | Claims | Share | National share |
|---|---|---|---|
| Referral required | 72,471 | 24.6% | 8.4% |
| Administrative reason | 53,474 | 18.1% | 22.5% |
| Member not covered | 40,874 | 13.9% | 6.6% |
| Provider out of network | 34,975 | 11.9% | 9.8% |
| Other reasons | 32,276 | 11% | 32.3% |
| Service excluded from the plan | 25,991 | 8.8% | 11.6% |
| Not medically necessary | 19,104 | 6.5% | 4.6% |
| Benefit limit reached | 15,579 | 5.3% | 4.2% |
The last column is each reason's share of all categorized denials nationally, so you can see where Sunshine State Health Plan'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.
Runs entirely in your browser, the date you type is never sent to us and never stored. Open the full calculator →
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.
Questions
Is Sunshine State Health Plan's denial rate in Florida high?
20.2% against a national average of 18.7% across the plans in this dataset. It is above average. A denial rate describes the insurer, not the merits of your claim.
How many people appealed a Sunshine State Health Plan denial in Florida, and how many won?
437 internal appeals were filed against 256,694 denials, and the overturn rate was not separately reported. How many went on to independent external review is not on the record for Sunshine State Health Plan in Florida, that is the absence stated at the top of this page and sourced at the foot of it.
How does Sunshine State Health Plan compare with other insurers in Florida?
Of the 11 insurers in Florida with a reported denial rate, Sunshine State Health Plan ranks 6 highest at 20.2%. The highest in Florida is AvMed, Inc. at 27.3%; the lowest is Capital Health Plan at 6.5%.
What does Sunshine State Health Plan deny most often in Florida?
Referral required, 72,471 claims, 24.6% of this issuer's categorized denials, against 8.4% 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 Sunshine State Health Plan 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, Sunshine State Health Plan 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 Sunshine State Health Plan denial in Florida cost anything?
The internal appeal to Sunshine State Health Plan 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 Sunshine State Health Plan 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 Sunshine State Health Plan in Florida, so none is printed for it, an absent figure is not a count of none.
Sunshine State Health Plan sits at 20.2% in Florida against 18.7% nationally, and that is the whole of what this page can honestly tell you about your own claim. I am 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 me and I will correct the page.
, Andrew at Axion Labs · hello@getaxionlabs.comEverything you need for your Sunshine State Health Plan appeal in Florida: your two deadlines, the argument that fits your denial reason, the letters, the clinician brief, 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 Sunshine State Health Plan figures on this page, the 20.2% denial rate, the 256,694 denials, are this issuer’s own reported rows in that file. CMS did not report an external-review figure for Sunshine State Health Plan in Florida in the plan-year 2026 release of the Transparency in Coverage file, which is why no external-review count appears above.
Counts: CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 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).