Denial Facts

Claim denial rates by state

By Axion Labs · August 19, 2026, updated November 4, 2026

Where insurers deny most, and how few denials are ever independently reviewed. Covers the 29 states with individual-market plans reporting in the federal file.

StateDenial rateClaims deniedExternal reviewsRelease
Hawaii26.3%203,1270plan-year 2027
Alaska24.8%245,5460plan-year 2027
Delaware20.3%449,3810plan-year 2027
Wyoming20.2%352,9010plan-year 2027
West Virginia20.1%707,6100plan-year 2027
North Carolina19.7%5,857,465121plan-year 2027
Louisiana18.7%2,363,981211plan-year 2027
Iowa17.7%915,03137plan-year 2027
Michigan17.7%2,967,990119plan-year 2027
Tennessee17.5%3,896,62766plan-year 2027
The paid next step, after the ranking above. If the insurer says no again, the Appeal Kit dates each step from its notice and writes the claim-file and external-review requests, $29 once. 14-day refund, no questions, one email to hello@getaxionlabs.com. If the independent reviewer upholds the denial, send us the decision and we refund.
StateDenial rateClaims deniedExternal reviewsRelease
Texas17.3%24,184,622158plan-year 2027
Utah17.3%1,967,8743,028plan-year 2027
Oklahoma17%2,116,24034plan-year 2027
Nebraska16.6%325,33212plan-year 2027
Alabama16.3%4,616,56932plan-year 2027
Arizona16.1%1,449,189294plan-year 2027
South Carolina15.7%3,573,275261plan-year 2027
Wisconsin15.4%1,893,07012plan-year 2027
Arkansas13.5%1,437,7350plan-year 2027
Florida13.5%17,515,496269plan-year 2027
Kansas12.7%969,53257plan-year 2027
Montana12.7%323,0190plan-year 2027
Ohio12.7%1,509,307114plan-year 2027
Missouri11.7%1,592,55112plan-year 2027
Mississippi11.2%1,141,6750plan-year 2027
Indiana10.6%973,29381plan-year 2027
New Hampshire8%158,4900plan-year 2027
North Dakota6.8%105,7860plan-year 2027
South Dakota5.9%95,1380plan-year 2027

Every state in the table above is in the plan-year 2027 file, ranked against the same release. Source: CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 claims), data.healthcare.gov — US Government public domain.

Carried forward from an earlier release, not ranked

Two states are not in the plan-year 2027 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.

StateDenial rateClaims deniedExternal reviewsLast release reporting it
Georgia15.8%4,235,21023plan-year 2024
Illinois19.6%2,948,254113plan-year 2025
Oregon10.9%277,49847plan-year 2026

The same figures as a chart

Health insurance claim denial rates by state Share of in-network claims denied, individual-market Qualified Health Plans on the federal Exchange (29 states reporting) 5%10%15%20%25% Hawaii26.3% · 774K claims Alaska24.8% · 991K claims Delaware20.3% · 2.2M claims Wyoming20.2% · 1.7M claims West Virginia20.1% · 3.5M claims North Carolina19.7% · 29.7M claims Louisiana18.7% · 12.6M claims Iowa17.7% · 5.2M claims Michigan17.7% · 16.7M claims Tennessee17.5% · 22.2M claims Texas17.3% · 139.5M claims Utah17.3% · 11.4M claims Oklahoma17% · 12.5M claims Nebraska16.6% · 2.0M claims Alabama16.3% · 28.4M claims Arizona16.1% · 9.0M claims South Carolina15.7% · 22.8M claims Wisconsin15.4% · 12.3M claims Arkansas13.5% · 10.7M claims Florida13.5% · 129.6M claims Kansas12.7% · 7.6M claims Montana12.7% · 2.5M claims Ohio12.7% · 11.9M claims Missouri11.7% · 13.6M claims Mississippi11.2% · 10.2M claims Indiana10.6% · 9.1M claims New Hampshire8% · 2.0M claims North Dakota6.8% · 1.6M claims South Dakota5.9% · 1.6M claims US average 15.7% Data: CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 claims), data.healthcare.gov — US Government public domain Chart: denialfacts.com, free to embed with attribution and a link to https://denialfacts.com
Embed this chart. Copy the snippet below, or take the image itself. The chart is free to embed on any site; the snippet carries the credit link to https://denialfacts.com/states, and the image is redrawn from the data, so it stays current. 
<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>
Work out your two deadlines

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.

Axion Labs · hello@getaxionlabs.com
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.
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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

Which states run their own external review and which use the federal process is read from the CCIIO state external review table, read August 3, 2026. Every state page prints its own route.

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).

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.

Your words, in a box, read by a person. We ask for no name and no email.