# Denial Facts (denialfacts.com)
Checked 5 September 2026
> Measured US health-insurance claim-denial data, computed from the CMS Transparency in Coverage Public Use File. 185 insurer-state records across 30 states, 84,502,749 in-network denials, the state-vs-federal external-review route for every covered state, 9 denial-reason categories with national volumes, a free composed answer API, a free deadline calculator, and one paid product at $29.
> Publisher: Axion Labs. Written and maintained by Andrew at Axion Labs, one person reads the mail and answers it: hello@getaxionlabs.com. Independent, not an insurer, agency, review organization, law firm, or medical provider.
> This file is generated from the live dataset on every request. Figures here match the site and the API exactly.
> For agents, machine-first orientation (everything callable here, trust blocks, gateway, fair use, in one fetch): https://denialfacts.com/for-agents (JSON: https://denialfacts.com/for-agents.json)
> Door Passport (machine-readable: provider, capabilities, data required/retained, pricing, trust, dispute contact): https://denialfacts.com/.well-known/agent-door.json
> Changes: https://denialfacts.com/changes.json · https://denialfacts.com/changes.atom (Atom 1.0), what moved, when, from where. OpenAPI 3.1 for every free endpoint: https://denialfacts.com/openapi.json. Every machine surface here carries ETag + Last-Modified and answers a matching If-None-Match or If-Modified-Since with HTTP 304 Not Modified and an empty body.

## What this site uniquely holds
The CMS Transparency in Coverage PUF is public, but it ships as raw plan-level filings that nobody reads. We aggregate it to the level a person actually asks about, "what does MY insurer deny, in MY state, for MY reason, and where does my appeal go", and publish the result free, as pages and as JSON.
- 185 issuer-state records (26 of which the CMS file reports no figures for at all; those pages are noindex and marked ", ", never invented)
- 30 states with reported figures, each mapped to its external-review route
- 9 denial-reason categories with national claim counts
- Source: CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 claims), data.healthcare.gov — US Government public domain
- Release: the plan-year 2026 file, issued September 26, 2025, covering plan-year 2024 claims. This is the newest plan year CMS has published: there is no Transparency in Coverage file for a plan year after 2026. One CMS file does carry a later issue date: the plan-year 2025 release was issued September 30, 2025, four days after this one. That is the PRIOR plan year, not a newer release, we publish by plan year, and both files are listed at https://data.healthcare.gov/. A test in this site's build fetches that list on every run and fails if CMS publishes a later plan year. Quote these numbers as the plan-year 2026 release.
- Trend across all three releases CMS has published: PY2024 (issued April 14, 2025, PY2022 claims): 57,590,788 denials, 2,336 external reviews, 44% overturned, 209 issuer-state records, 32 states | PY2025 (issued September 30, 2025, PY2023 claims): 85,894,625 denials, 5,000 external reviews, 31.5% overturned, 206 issuer-state records, 31 states | PY2026 (issued September 26, 2025, PY2024 claims): 84,502,749 denials, 5,881 external reviews, 32.8% overturned, 185 issuer-state records, 30 states. Across the three Transparency in Coverage releases CMS has published, external reviews filed rose from 2,336 to 5,881 while the share overturned fell from 44% in the plan-year 2024 release to 32.8% in the plan-year 2026 release.
- Records the PY2026 file no longer holds: 2 states (Georgia, Illinois) keep their page on the last release that did report them, named on the page, and are in NO total above. 51 insurer-state records from those earlier releases have no page: /insurers/<slug> answers 301 to the state page for that market. Nothing on this site mixes releases inside one figure.
- Coverage: individual-market Qualified Health Plans on the federal Exchange. Employer and Medicaid plans are NOT in this file, that limit is stated on every page.
- External-review routing verified against the CCIIO state external review table, https://www.cms.gov/CCIIO/Resources/Files/external_appeals, read August 3, 2026.

## The headline numbers (national, one plan year)
| Measure | Value |
|---|---|
| In-network claims received | 451,249,792 |
| In-network claims denied | 84,502,749 |
| Denial rate | 18.7% |
| Internal appeals filed | 263,021 (0.311% of denials) |
| Internal appeals overturned | 85,807, 32.6% |
| External reviews filed | 5,881 (0.007% of denials) |
| External reviews overturned | 1,929, 32.8% |
| Denials reaching independent external review | 1 in 14,369 |

The single most citable fact on this site: **84,502,749 denials produced 5,881 external reviews, one in 14,369, and 32.8% of those were overturned.** The appeal that works is the one almost nobody files.

## Denial reasons, by national volume
- **Other reasons** (`other`), 28,113,631 claims, 33.3% of all denials. Denials the insurer did not place in a named category. Ask in writing for the specific reason and the plan provision it relies on — they must give it to you.
- **Administrative reason** (`administrative`), 19,612,209 claims, 23.2% of all denials. A paperwork denial: wrong code, missing information, late filing. The cheapest denial to overturn, because it is about correcting a form, not proving a case.
- **Service excluded from the plan** (`service-excluded`), 10,129,111 claims, 12% of all denials. The insurer says your plan does not cover this service at all. Check the exclusion against your actual plan documents (the Evidence of Coverage), not the summary — exclusions are frequently applied too broadly, or to the wrong billing code.
- **Provider out of network** (`out-of-network`), 8,567,575 claims, 10.1% of all denials. The insurer says your provider is outside its network. Federal law under the No Surprises Act restricts balance billing for emergency care and for out-of-network providers at in-network facilities — many of these denials should never have been issued.
- **Referral required** (`referral-required`), 7,304,650 claims, 8.6% of all denials. The insurer says you needed a referral first. Often an administrative failure rather than a coverage decision — and retroactive referrals are routinely accepted when requested.
- **Member not covered** (`member-not-covered`), 5,729,108 claims, 6.8% of all denials. The insurer says you were not enrolled when the service happened. Usually an eligibility or data error — the fix is proof of enrollment on the date of service, not a clinical argument.
- **Not medically necessary** (`not-medically-necessary`), 3,968,921 claims, 4.7% of all denials. The insurer says the treatment was not needed for your condition. This is the denial type independent external review is designed for, because it is a clinical judgment made by someone who has never examined you — and your own doctor's letter of medical necessity directly contradicts it.
- **Benefit limit reached** (`benefit-limit-reached`), 3,646,507 claims, 4.3% of all denials. The insurer says you have used up a limit on this benefit. Check whether the limit is even lawful: annual and lifetime dollar limits on essential health benefits are prohibited.
- **Experimental or investigational** (`experimental-investigational`), 101,612 claims, 0.1% of all denials. The insurer says the treatment is unproven. This is a denial type external review is well suited to, because independent reviewers judge it against current clinical evidence rather than the insurer's internal policy.

## Highest denial rates (insurers processing >200,000 in-network claims)
| Insurer | State | Denial rate | Claims denied | External reviews filed |
|---|---|---|---|---|
| AmeriHealth Caritas North Carolina, Inc. | North Carolina | 28.2% | 109,227 | 0 |
| Oscar Health Plan, Inc. | Arizona | 28.1% | 82,246 | 152 |
| Meridian Health Plan of Michigan, Inc. | Michigan | 27.7% | 941,541 | not reported |
| Cigna Health and Life Insurance Company | Mississippi | 27.7% | 691,183 | not reported |
| Hawaii Medical Service Association | Hawaii | 27.4% | 198,069 | 0 |
| AvMed, Inc. | Florida | 27.3% | 118,089 | 0 |
| Premera Blue Cross Blue Shield of Alaska | Alaska | 27% | 210,082 | not reported |
| Oscar Buckeye State Insurance Corp. | Ohio | 26.5% | 337,922 | 394 |
| UnitedHealthcare Community Plan, Inc. | Michigan | 26.3% | 204,912 | 0 |
| Oscar Insurance Company | Kansas | 26.1% | 77,239 | 80 |
| Medica Insurance Company | Oklahoma | 26% | 103,679 | 0 |
| Oscar Insurance Company | Texas | 25.5% | 764,285 | 517 |
| Oscar Insurance Company | Iowa | 25.1% | 117,430 | 144 |
| Health Options, Inc. | Florida | 24.7% | 10,507,969 | 153 |
| Oscar Insurance Company | Missouri | 24.5% | 133,294 | 53 |
| UnitedHealthcare Insurance Company | Louisiana | 24.1% | 248,739 | not reported |
| Celtic Insurance Company | Oklahoma | 24% | 438,378 | not reported |
| Molina Healthcare of Texas, Inc. | Texas | 24% | 237,126 | 21 |
| UnitedHealthcare of Arizona, Inc. | Arizona | 23.8% | 646,181 | 33 |
| Molina Healthcare of Florida, Inc | Florida | 23.6% | 341,296 | 0 |
| CareSource West Virginia Co. | West Virginia | 23.6% | 198,752 | 54 |
| Oscar Insurance Company | Tennessee | 23.5% | 187,709 | 162 |
| Medica Insurance Company | Missouri | 23.4% | 95,180 | 0 |
| UnitedHealthcare of Ohio, Inc. | Ohio | 23.2% | 208,089 | 21 |
| Oscar Insurance Company | Oklahoma | 23.2% | 60,135 | 83 |

## Largest by absolute volume of denials
| Insurer | State | Claims denied | Denial rate | Top denial reason |
|---|---|---|---|---|
| Blue Cross Blue Shield of Texas | Texas | 11,028,737 | 18.8% | Other reasons |
| Health Options, Inc. | Florida | 10,507,969 | 24.7% | Administrative reason |
| Blue Cross and Blue Shield of Florida | Florida | 4,251,990 | 19.1% | Other reasons |
| Blue Cross and Blue Shield of NC | North Carolina | 3,116,071 | 19.3% | Other reasons |
| Celtic Insurance Company | Texas | 2,652,607 | 16.3% | Administrative reason |
| UnitedHealthcare of Texas, Inc. | Texas | 2,550,560 | 17.4% | Provider out of network |
| Blue Cross and Blue Shield of Alabama | Alabama | 2,038,603 | 19% | Service excluded from the plan |
| Blue Cross and Blue Shield of South Carolina | South Carolina | 1,827,005 | 15.5% | Other reasons |
| Ambetter of Magnolia Inc. | Mississippi | 1,824,195 | 16% | Administrative reason |
| Celtic Insurance Company | Tennessee | 1,645,943 | 18.9% | Administrative reason |
| SelectHealth, Inc. | Utah | 1,571,221 | 18.7% | Other reasons |
| Absolute Total Care, Inc | South Carolina | 1,471,467 | 18.3% | Administrative reason |
| Community Health Choice, Inc. | Texas | 1,449,319 | 21.4% | Other reasons |
| Blue Cross Blue Shield of Oklahoma | Oklahoma | 1,385,537 | 16.4% | Other reasons |
| BlueCross BlueShield of Tennessee | Tennessee | 1,323,501 | 21.1% | Administrative reason |
| Celtic Insurance Company | Arkansas | 1,297,980 | 16.1% | Administrative reason |
| Superior Health Plan | Texas | 1,287,305 | 22.2% | Referral required |
| Scott and White Health Plan | Texas | 1,205,777 | 14.6% | Other reasons |
| Celtic Insurance Company | Missouri | 1,113,385 | 18.8% | Administrative reason |
| UnitedHealthcare Insurance Company | Alabama | 1,073,259 | 17.9% | Provider out of network |

## Every state: denial rate, external-review route, and appeal volume
Route matters more than the rate. A "federal process" state is one CMS lists as NOT having a state external review process meeting the federal standards, insurers there use the HHS-administered federal process or a contracted independent review organization. CMS says that process reopened on July 31, 2026 after a pause that began July 1, 2026; anyone who could not file between then and August 3, 2026 may be eligible for an extension to October 2, 2026; HealthCare.gov says the extension may also reach a state or local government plan in any state. Sources, both read September 5, 2026: https://www.cms.gov/CCIIO/Resources/Files/external_appeals and https://www.healthcare.gov/appeal-insurance-company-decision/external-review/.

| State | Denial rate | Claims denied | Insurers | External reviews filed | External review route |
|---|---|---|---|---|---|
| Hawaii | 27% | 198,653 | 2 | 0 | State-run |
| Alaska | 25.3% | 239,313 | 2 | 0 | State-run |
| Florida | 22.2% | 18,256,139 | 16 | 429 | Federal / contracted IRO |
| West Virginia | 21% | 669,877 | 2 | 54 | State-run |
| Arizona | 20.1% | 1,581,162 | 7 | 365 | State-run |
| Tennessee | 20.1% | 4,559,085 | 6 | 162 | State-run |
| North Carolina | 19.9% | 4,713,568 | 7 | 122 | State-run |
| Delaware | 19.7% | 440,631 | 3 | 0 | State-run |
| Nebraska | 19.6% | 383,930 | 5 | 44 | State-run |
| Illinois | 19.6% | 2,948,254 | 11 | 113 | State-run |
| Alabama | 18.9% | 3,464,098 | 4 | 13 | Federal / contracted IRO |
| Iowa | 18.8% | 911,035 | 6 | 144 | State-run |
| Louisiana | 18.6% | 1,738,366 | 6 | 288 | State-run |
| Utah | 18.6% | 1,781,916 | 6 | 130 | State-run |
| Texas | 18.5% | 22,372,063 | 18 | 1,908 | Federal / contracted IRO |
| Mississippi | 18.3% | 2,725,739 | 5 | 0 | State-run |
| Oklahoma | 18.3% | 2,122,396 | 7 | 133 | State-run |
| Kansas | 18.2% | 1,148,305 | 6 | 109 | State-run |
| Ohio | 17.9% | 2,934,307 | 11 | 954 | State-run |
| Wyoming | 17.6% | 229,909 | 2 | 0 | State-run |
| Michigan | 17.4% | 2,371,866 | 8 | 189 | State-run |
| South Carolina | 17% | 3,656,371 | 6 | 234 | State-run |
| Arkansas | 15.9% | 2,848,075 | 6 | 35 | State-run |
| Georgia | 15.8% | 4,235,210 | 10 | 23 | Federal / contracted IRO |
| Missouri | 15.6% | 1,900,841 | 8 | 53 | State-run |
| Indiana | 15.2% | 980,842 | 5 | 436 | State-run |
| Wisconsin | 12.1% | 1,188,325 | 12 | 0 | Federal / contracted IRO |
| Montana | 11.6% | 234,099 | 3 | 32 | State-run |
| Oregon | 10.9% | 277,498 | 6 | 47 | State-run |
| New Hampshire | 10.4% | 321,334 | 4 | 0 | State-run |
| North Dakota | 9.8% | 140,595 | 3 | 0 | State-run |
| South Dakota | 6.5% | 112,411 | 3 | 0 | State-run |

- Federal-process states in this dataset (4): Alabama, Florida, Texas, Wisconsin
- State-run-process states (26): Alaska, Arizona, Arkansas, Delaware, Hawaii, Indiana, Iowa, Kansas, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Utah, West Virginia, Wyoming
- **The route column above is for INSURED plans only.** Self-funded employer plans use the FEDERAL external review process in every state, see "Does my state or the federal government handle my external review?" below before citing a state route for anyone with employer coverage.
- States where NOT ONE denial reached external review in the reported year (9): Alaska, Delaware, Hawaii, Mississippi, New Hampshire, North Dakota, South Dakota, Wisconsin, Wyoming

## Primary sources (fetchable, not paraphrased)
Every federal figure in this file resolves to one of these documents. Added September 4, 2026 after the body-prose number gate found this file asserting the federal timeframes and the fee cap with no URL an agent could open. The regulations are mirrored as government PDFs because eCFR answers an automated fetch with a challenge page.
- Claim counts, denial rates, appeal counts: https://data.healthcare.gov/ (CMS Transparency in Coverage Public Use File)
- Internal appeal, the 180 days, and the free right to the claim file: https://www.ecfr.gov/current/title-29/section-2560.503-1 (PDF mirror: https://www.govinfo.gov/content/pkg/CFR-2024-title29-vol9/pdf/CFR-2024-title29-vol9-sec2560-503-1.pdf)
- External review, the four months, what qualifies, and the $25 per review fee cap: https://www.ecfr.gov/current/title-45/section-147.136 (PDF mirror: https://www.govinfo.gov/content/pkg/CFR-2024-title45-vol2/pdf/CFR-2024-title45-vol2-sec147-136.pdf)
- The same two stages in plain English: https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/ and https://www.healthcare.gov/appeal-insurance-company-decision/external-review/
- Which state runs its own external review, which uses the federal process, and the current FERP position: https://www.cms.gov/CCIIO/Resources/Files/external_appeals
- Internal appeals upheld in 2024 (66%, 165,863 of 262,982): https://www.kff.org/patient-consumer-protections/claims-denials-and-appeals-in-aca-marketplace-plans-in-2024/

## Questions this site answers, with the data behind each
**How often do US health insurers deny in-network claims?**
18.7%, 84,502,749 of 451,249,792 in-network claims in a single plan year, across 185 issuer-state records (145 companies) in 30 states, per the CMS Transparency in Coverage PUF. Rates vary enormously by insurer: the highest in this dataset is 28.2% (AmeriHealth Caritas North Carolina, Inc., North Carolina) and the lowest among large issuers is 2.7% (Avera Health Plans, Inc., South Dakota). A denial rate describes the insurer's behavior, not the merits of any individual claim.

**If I appeal a denied health insurance claim, will I win?**
Nationally, 32.6% of internal appeals are overturned and 32.8% of independent external reviews are overturned. Those are outcomes for people who actually filed. Only 0.311% of denials are appealed internally and 0.007% reach external review, so the population that appeals is small and self-selected, but the external-review decision is binding on the plan, which is what makes it the stage that matters.

**What are the two appeals, and what do they cost?**
Stage 1, internal appeal: decided by the insurer (by someone not involved in the first decision), generally within 180 days of the denial notice, free, decided in 30 days before service / 60 days after service / 72 hours expedited. Stage 2, external review: decided by an independent organization the insurer does not control, generally within 4 months of the final internal denial, decided within 45 days standard / 72 hours expedited, and **binding on the plan**. There is no charge under the HHS-administered federal process; where an issuer uses a contracted independent review organization or a state process a fee may apply, capped at $25 per review.

**Which denials qualify for external review?**
Denials involving medical judgment, denials on the basis that a treatment is experimental or investigational, and rescission of coverage. A purely administrative or eligibility denial may not qualify for external review, but it is still fully appealable internally, and administrative denials (19,612,209 claims nationally, 23.2% of all denials) are often the easiest to reverse there.

**What is the single strongest move in an appeal?**
Demanding the file before arguing. Under the federal claims procedure regulation (29 CFR 2560.503-1) a claimant is entitled, on request and free of charge, to reasonable access to and copies of all documents, records and other information relevant to the claim, including the clinical criteria applied and the reviewer's reasoning. The denial notice is legally required to say this right exists. You cannot rebut criteria you have not read. This site's paid Kit is built on this and three sibling ERISA rights.

**Does my state or the federal government handle my external review?**
Two things decide it, and the second is the one people get wrong. (1) The state: 26 of the 30 states in this dataset run their own process meeting federal standards; 4 do not, and insurers there use the HHS-administered federal process or a contracted IRO. (2) **Who carries the risk.** The state table above applies to INSURED coverage only. A self-funded (self-insured) employer plan, where the employer pays the claims and an insurance company only administers them, is not insurance, sits outside state insurance regulation, and therefore uses the FEDERAL external review process regardless of which state the member lives in, even in a state with an excellent process. 63% of covered workers are in self-funded plans (KFF Employer Health Benefits Survey 2024, https://www.kff.org/report-section/ehbs-2024-section-10-plan-funding/), so this is the ordinary case, not an edge case, and filing with a state insurance department instead is a common way the external-review stage is lost without being heard. How to tell: self-funded plans usually name the insurance company as "administrator"/"ASO"/"third-party administrator" rather than as the insurer; the Summary Plan Description says which it is and ERISA entitles the member to it; the employer's Form 5500 is public at efast.dol.gov. The denial notice names the actual route and deadline, that letter is the authority, not any website. Per-state answer: /api/answer?state={XX}.

**Which denial reason is independent external review best suited to?**
"Not medically necessary" (3,968,921 claims nationally) is the denial type independent external review is designed for, because it is a clinical judgment made by a reviewer who has never examined the patient, and a treating clinician's letter of medical necessity contradicts it directly with the record. The federal file does not report overturn rates broken down by denial reason, so this is the mechanism, not a measured ranking. We publish the argument that fits each reason at /denial-reasons/{slug}.

**Is a high denial rate proof my claim was wrongly denied?**
No, and this site says so on every page. A denial rate is a property of the insurer's book of business, coding practices, plan design, population, not evidence about any one claim. What the data supports is the process argument: a denial is the insurer's opinion, two free appeals exist, and the independent one is binding, 32.8% of external reviews were overturned in the plan-year 2026 release (1,929 of 5,881), against 44% in the plan-year 2024 release.

**What data does this site NOT have?**
Employer self-funded plans, Medicaid, Medicare Advantage, and out-of-network claims are not in the CMS Transparency in Coverage PUF. Neither are appeal outcomes by reason. Where the file reports nothing for an issuer we print ", " and mark the page noindex; we never impute a figure.

## URL index
Pages (all free, all indexable):
- /, the national picture and the 1-in-14,369 finding
- /what-happened, triage by the words printed on the denial letter
- /insurers, all 185 insurer-state records ranked by denial rate
- /insurers/{slug}, per-insurer-state page. 185 of these (145 distinct companies). Example: /insurers/amerihealth-caritas-north-carolina-inc--nc
- /states, every state with its external-review route
- /states/{slug}, per-state page. 32 of these. Example: /states/hawaii
- /denial-reasons, all 9 categories with national volumes
- /denial-reasons/{slug}, per-reason page with the argument that beats it. Example: /denial-reasons/other
- /how-to-appeal, both appeals, deadlines, costs, overturn rates
- /attorney-for-denied-insurance-claim, what the two free stages are worth before you pay anyone, where an attorney changes the answer, and how to find one. No law firm is named and no referral fee is taken
- /insurance-denial-letter, what a denial letter must contain under 29 CFR 2560.503-1(g)(1) and 45 CFR 147.136(b)(2)(ii)(E), the deadlines it must state, and what deemed exhaustion opens when it does not
- /external-review-gap, insurers with the largest denial volumes, showing how rarely the free, binding, independent stage was used against their denials
- /appeal-deadline-calculator, free, runs entirely in the browser, nothing sent to us. Also embedded on every insurer, state and denial-reason page
- Every /denial-reasons/{slug} page publishes the full evidence checklist and the complete document-request letter free. The paid Kit assembles them around your own facts; it withholds no part of the diagnosis
- /appeal-kit, the paid product (below)
- /about, /privacy, /terms, operator identity and publishing principles
- /sitemap.xml, /robots.txt

Free JSON API (CORS open, no key, no rate limit, attribution requested):
- /api/answer?insurer={slug}&state={XX}&reason={slug}, THE endpoint. All three params optional and combinable. Returns in one object: the denial rate for that insurer and state, the state's external-review route with deadlines and any active federal-process notice, the applicable federal appeal rights including the four ERISA claims-procedure rights with their CFR citations, the national baseline for comparison, and a citation block. Given only an insurer, its own state's route is resolved automatically.
- /api/insurers, index of all 185 insurer-state records with answer URLs
- /api/states, index of all 32 states with external-review route and answer URLs
- /api/reasons, index of all 9 denial reasons with national volumes
- /api/procedures, per-insurer appeal PROCEDURE facts, brand-level, quoted verbatim from each insurer's own published policy: which denial scenarios the MEMBER appeals vs which only the PROVIDER can appeal (the routing table almost no patient ever sees), filing windows, submission routes. Currently covers: Cigna Healthcare, UnitedHealthcare, Aetna, Anthem (Elevance Health), Blue Cross and Blue Shield of Alabama, Kaiser Permanente, Ambetter (Centene), Molina Healthcare, Florida Blue (Blue Cross and Blue Shield of Florida), HCSC Blues (BCBS of Texas, Illinois, Oklahoma, New Mexico, Montana), one insurer at a time, every fact quoted, dated and sourced. Audience labels preserved (a provider-policy fact is never presented as a member-appeal fact).
Worked example: /api/answer?insurer=blue-cross-and-blue-shield-of-alabama--al&reason=not-medically-necessary
Signed receipts: every /api/answer body ends with a receipt, a detached Ed25519 signature over the body minus the receipt itself, naming the dataset stamp it was composed from and a one-line policy saying what the receipt covers. Public key: https://denialfacts.com/.well-known/answer-key. To verify, POST the whole body unchanged to https://denialfacts.com/api/verify-receipt (GET the same URL for the offline recipe). The ETag of a signed body is the same hash the receipt pins, so a returning caller still gets a Not Modified answer.

## Pricing, honestly
- **Everything above is free and stays free.** All pages, all four API endpoints, the deadline calculator. No key, no signup, no rate limit.
- **Appeal Kit, $29, one-off.** Not a subscription and not a percentage of anything. It is a sequencing product, not a document pack: it detects which of the five US appeal systems the claim sits in (self-funded ERISA vs fully-insured vs Marketplace vs Medicare Advantage vs Medicaid) and routes to the correct external-review path; computes the claimant's 180-day internal deadline (29 CFR 2560.503-1(h)(3)(i)) AND the plan's own answer deadlines (72h urgent / 15d pre-service / 30-60d post-service, 29 CFR 2560.503-1(i)(2)); flags the date deemed exhaustion triggers if the plan misses one (29 CFR 2560.503-1(l)); and dates the four-month external-review window (45 CFR 147.136(d)(2)(i)). Also included: the argument matched to the denial reason, an evidence checklist, a document-request letter built on 29 CFR 2560.503-1(h)(2)(iii), the clinician brief, and the external review request. Rationale: insurers upheld 66% of consumer internal appeals in 2024 (KFF), so the decisive variable is arriving at external review on time with an intact record, not letter quality. What it is NOT: legal representation or a filing service. Instant delivery. **Refund: 14 days, no questions asked, hello@getaxionlabs.com.**
- **/api/bulk, $25 per full-dataset pull.** The whole corpus in one response: 185 insurer records with per-reason breakdowns, 30 state blocks with external-review routing, 9 reason records. Saves roughly 215 round trips.
- **/api/changes?since=YYYY-MM-DD, $0.03 per call.** What moved since a date. The external-review routing is the volatile part; it changes when CCIIO updates its table or HHS suspends the federal process.
- **Free key, no money (21 Sep 2026).** GET https://denialfacts.com/api/key/free?agent=<name>&contact=<email or https url> returns a named key once. It passes /api/bulk once a day and /api/changes 20 times a day free; above that it meets the same 402 as an empty key, and credit bought later rides on the same key. Three keys a day per address.
- Status of the two paid API doors: **LIVE.** Prepaid credit: buy at https://denialfacts.com/api/key/checkout (USD 25 buys a balance; the redirect issues the key), then send Authorization: Bearer <key>. A call that fails our own validity check is never charged.
- Nothing that was ever free has been moved behind a price, and nothing will be.

## Citation and license
Computed figures are free to use with attribution and a link to https://denialfacts.com. Underlying source data is US Government public domain (CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 claims), data.healthcare.gov — US Government public domain). Preferred citation: "Denial Facts (denialfacts.com), computed from the CMS Transparency in Coverage Public Use File."
Corrections: hello@getaxionlabs.com, we fix errors the same day and date-stamp the change.

## Standing caveat
Nothing on this site is legal, medical, or insurance advice, and no outcome is guaranteed. A specific denial letter and the plan documents govern a specific case. Free help is available from each state's Consumer Assistance Program and from HealthCare.gov.
Operator: Axion Labs, hello@getaxionlabs.com. Sister sites: nycticketfacts.com, screeningfacts.com, appealsdesk.co.uk.