Denied in Florida? Here is the phone number, then the date.
Put in the date on your notice and get both federal deadlines as calendar dates.
Free, for a 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.
It also tells you whether your external review goes to Florida or to the federal process, the part that is not the same in every state.
The Florida consumer service is open 8:00 AM - 5:00 PM ET, Monday through Friday., and it can tell you whether your external review goes to the state or to the federal process, and in some cases it will file for you. That call costs nothing and does not use up your 180 days. The complaint form is here.
Read from myfloridacfo.com on September 9, 2026. If the number has changed, tell us and we will fix it the same day.Insurers in Florida denied 18,256,139 in-network claims in this release, 22.2% of everything submitted.
Insurance company denied claim. What do we do?
Those are the plan-year 2026 release figures, from the federal Transparency in Coverage file issued September 26, 2025. Just 429 of those Florida denials reached independent external review, and 40.6% of those were overturned.
The deadlines are federal, so they are the same in every state. 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 in this, and it can be measured: insurers in Florida denied 18,256,139 in-network claims in a single plan year across 16 reporting insurers. Of those denials, 429 reached the one stage whose decision the insurer has to obey.
- Among the 30 states in the federal file, Florida has the third highest denial rate at 22.2%, against a national 18.7%.
- Which insurer you happen to be with matters more here than the state average does: inside Florida the reported rates run from 27.3% (AvMed, Inc.) down to 6.5% (Capital Health Plan).
- For every 10,000 claims denied in Florida, about 7 came back as an internal appeal.
- Of 18,256,139 denials, 429 reached independent external review, about 23.5 for every million denied claims.
- The reason recorded most often in Florida is other reasons, 42.7% of its categorized denials against 32.3% nationally.
- Find the reason code on your denial letter. Whichever of the 16 insurers reporting in Florida sent it, the notice has to state the specific reason and the plan provision behind it. Copy both onto paper tonight.
- Ask your insurer 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. 429 external reviews were filed in Florida against 18,256,139 denials. Missing the date 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.
What that Florida external-review count means for your own denial, and by when. 429 independent external reviews were filed in Florida against 18,256,139 denials, and 40.6% of them were overturned, Florida's own 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, and the Florida route at the end of them is on this page. Nothing on this page is for sale: the consumer line above, the letter and the deadline calculator are all free, and none of them asks for an email.
Insurers in Florida
| Insurer | Denial rate | Denied | External reviews |
|---|---|---|---|
| AvMed, Inc. | 27.3% | 118,089 | 0 |
| AmeriHealth Caritas Florida, Inc. | 25.7% | 20,441 | 0 |
| Health Options, Inc. | 24.7% | 10,507,969 | 153 |
| Molina Healthcare of Florida, Inc | 23.6% | 341,296 | 0 |
| Health First Commercial Plans, Inc. | 22.4% | 475,722 | 37 |
| Sunshine State Health Plan | 20.2% | 256,694 | not reported |
| UnitedHealthcare of Florida, Inc. | 20.2% | 719,832 | 18 |
| Cigna Health and Life Insurance Company | 20% | 926,080 | 15 |
| Blue Cross and Blue Shield of Florida | 19.1% | 4,251,990 | 170 |
| Florida Health Care Plan, Inc. | 17% | 602,771 | 36 |
| Capital Health Plan | 6.5% | 35,255 | not reported |
| Centene Venture Company Florida | not reported | not reported | not reported |
| Cigna HealthCare of Florida, Inc. | not reported | not reported | not reported |
| Community Care Network Inc | not reported | not reported | not reported |
| Oscar Health Maintenance Organization of Florida | not reported | not reported | not reported |
| Simply Healthcare Plans Inc dba Wellpoint Florida Inc | not reported | not reported | not reported |
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 →
Questions about appealing in Florida
What percentage of health insurance claims are denied in Florida?
22.2%, insurers in Florida denied 18,256,139 of 82,397,280 in-network claims across 16 reporting insurers, in the plan-year 2026 release of the CMS Transparency in Coverage Public Use File. The national rate in the plan-year 2026 release is 18.7%.
Does Florida run its own external review, or does the federal process apply?
CMS lists Florida among the states without an external review process meeting the federal standards. Insurers there must use either the HHS-administered federal process or an independent review organization they contract with. Note: CMS says that process reopened on July 31, 2026, and that anyone who could not file between July 1, 2026 and August 3, 2026 may have until October 2, 2026 to request external review, and HealthCare.gov adds that the extension may also reach a state or local government plan in any state. Sources: the CCIIO state external review table (route), read August 3, 2026; the CCIIO page and HealthCare.gov on external review (the reopening and the extension), both read September 5, 2026.
My plan is through my job, does this state route apply to me?
Only if an insurance company carries the risk. If your employer pays the claims itself, a self-funded or self-insured plan, which is 63% of covered workers, your plan is not insurance and is outside state insurance regulation, so Florida's process does not apply to you and your external review goes through the federal process instead. Filing with the state insurance department in that situation is one of the most common ways the external-review stage is lost without ever being heard. Three free ways to check which you have: your ID card and plan documents (self-funded plans usually name the insurer as "administrator" or "third-party administrator"), the Summary Plan Description your employer must give you on request, and your employer's Form 5500 at efast.dol.gov. Your denial letter names your actual route and is the authority.
How much does external review cost in Florida?
Nothing under the HHS-administered federal process. Where an insurer uses a contracted independent review organization or a state process, a filing fee may apply but it cannot exceed $25 per review. The internal appeal is free in every case. Anyone asking you for more than that cap to file an external review is not describing the federal scheme.
How many people in Florida reached independent external review, and how many won?
429 external reviews were filed against 18,256,139 denials in Florida in the reported year, and 40.6% of those were overturned. Nationally, 32.8% of external reviews are overturned and the decision is binding on the plan.
Which insurer in Florida denies the most?
By rate, AvMed, Inc. at 27.3% of in-network claims (118,089 denied). 11 insurers in Florida report a denial rate; the lowest is Capital Health Plan at 6.5%. A denial rate describes the insurer's book of business, not the merits of an individual claim.
How long do I have to appeal a denial in Florida?
Appeal deadlines are federal, not state: generally 180 days from the denial notice for the internal appeal, then generally four months from the final internal denial to request external review. Expedited review is decided in about 72 hours where delay would seriously jeopardize your health. Your denial letter states the deadlines that govern your plan.
Florida runs 11 insurers with reported rates and they are not close to each other, that is the bit of this page I would not skip. The deadlines are federal, so they are the same wherever you live. What changes by state is who runs the independent review at the end, and getting that wrong is one of the most common ways people lose the last stage without ever being heard. That is why the route for this state is near the top of this page rather than in a footnote. If your plan is through a job, read the self-funded note carefully; it decides which door your review goes through.
, Andrew at Axion Labs · hello@getaxionlabs.comNothing on this page is for sale. The Florida consumer line above is free, the letter is free, and the deadline calculator is free. If you would rather have every step dated around your denial, the Appeal Kit is on its own page, you do not need it to use anything here.
The Florida figures on this page, 22.2%, 18,256,139 denials and 429 external reviews across 16 insurers, are the state’s own rows in the plan-year 2026 release, issued September 26, 2025. 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. The external-review route above comes from the CCIIO state external review table, read August 3, 2026.
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).