Claim denial rates by state
Where insurers deny most, and how few denials are ever independently reviewed. Covers the 30 states with individual-market plans reporting in the federal file.
| State | Denial rate | Claims denied | External reviews | Release |
|---|---|---|---|---|
| Hawaii | 27% | 198,653 | 0 | plan-year 2026 |
| Alaska | 25.3% | 239,313 | 0 | plan-year 2026 |
| Florida | 22.2% | 18,256,139 | 429 | plan-year 2026 |
| West Virginia | 21% | 669,877 | 54 | plan-year 2026 |
| Arizona | 20.1% | 1,581,162 | 365 | plan-year 2026 |
| Tennessee | 20.1% | 4,559,085 | 162 | plan-year 2026 |
| North Carolina | 19.9% | 4,713,568 | 122 | plan-year 2026 |
| Delaware | 19.7% | 440,631 | 0 | plan-year 2026 |
| Nebraska | 19.6% | 383,930 | 44 | plan-year 2026 |
| Alabama | 18.9% | 3,464,098 | 13 | plan-year 2026 |
| Iowa | 18.8% | 911,035 | 144 | plan-year 2026 |
| Louisiana | 18.6% | 1,738,366 | 288 | plan-year 2026 |
| Utah | 18.6% | 1,781,916 | 130 | plan-year 2026 |
| Texas | 18.5% | 22,372,063 | 1,908 | plan-year 2026 |
| Mississippi | 18.3% | 2,725,739 | 0 | plan-year 2026 |
| Oklahoma | 18.3% | 2,122,396 | 133 | plan-year 2026 |
| Kansas | 18.2% | 1,148,305 | 109 | plan-year 2026 |
| Ohio | 17.9% | 2,934,307 | 954 | plan-year 2026 |
| Wyoming | 17.6% | 229,909 | 0 | plan-year 2026 |
| Michigan | 17.4% | 2,371,866 | 189 | plan-year 2026 |
| South Carolina | 17% | 3,656,371 | 234 | plan-year 2026 |
| Arkansas | 15.9% | 2,848,075 | 35 | plan-year 2026 |
| Missouri | 15.6% | 1,900,841 | 53 | plan-year 2026 |
| Indiana | 15.2% | 980,842 | 436 | plan-year 2026 |
| Wisconsin | 12.1% | 1,188,325 | 0 | plan-year 2026 |
| Montana | 11.6% | 234,099 | 32 | plan-year 2026 |
| Oregon | 10.9% | 277,498 | 47 | plan-year 2026 |
| New Hampshire | 10.4% | 321,334 | 0 | plan-year 2026 |
| North Dakota | 9.8% | 140,595 | 0 | plan-year 2026 |
| South Dakota | 6.5% | 112,411 | 0 | plan-year 2026 |
Every state in the table above is in the plan-year 2026 file, ranked against the same release. Source: CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 claims), data.healthcare.gov — US Government public domain.
Carried forward from an earlier release, not ranked
Two states are not in the plan-year 2026 file at all. They moved off the federal Exchange platform, which is what the file records, not that denials stopped there. Their pages stay up with the last figures CMS reported and each names its own release, but they are not in the table above, not in the chart below, and in no total and no ranking anywhere on this site, because a row from one release ranked against rows from another prints a comparison no CMS file contains.
The same figures as a chart
<a href="https://denialfacts.com/states"><img src="https://denialfacts.com/embed/denial-rates-by-state.svg" alt="Health insurance claim denial rates by state, from the CMS Transparency in Coverage Public Use File" width="800"></a> <p style="font-size:13px">Source: <a href="https://denialfacts.com/states">Denial Facts, claim denial rates by state (CMS Transparency in Coverage file)</a></p>
The federal timeframes: 180 days from the date on the denial notice to file the internal appeal, then 4 months from the final internal denial to request independent external review. Put your date in and get the actual 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 →
Where you live does not change your deadlines. It changes the door your independent review goes through at the end, and that is worth knowing before you need it rather than after. Open your state, read the route, and write it on the letter beside the dates. If your coverage comes through a job, read the self-funded note there slowly, it is the thing people get wrong most often, and getting it wrong costs them the last stage without anyone ever hearing them.
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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).