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 17,515,496 in-network claims in this release, 13.5% of everything submitted.
Further down this page, after the free steps: the paid next step.
Insurance company denied claim. What do we do?
Those are the plan-year 2027 release figures, from the federal Transparency in Coverage file issued October 22, 2026. Just 269 of those Florida denials reached independent external review, and 34.9% 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 17,515,496 in-network claims in a single plan year across 12 reporting insurers. Of those denials, 269 reached the one stage whose decision the insurer has to obey.
- Among the 29 states in the federal file, Florida has the 20th highest denial rate at 13.5%, against a national 15.7%.
- Which insurer you happen to be with matters more here than the state average does: inside Florida the reported rates run from 96.2% (Capital Health Plan) down to 9.8% (Centene Venture Company Florida).
- For every 10,000 claims denied in Florida, about 10 came back as an internal appeal.
- Of 17,515,496 denials, 269 reached independent external review, about 15.4 for every million denied claims.
- The reason recorded most often in Florida is other reasons, 33.3% of its categorized denials against 32.4% nationally.
- Find the reason code on your denial letter. Whichever of the 12 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. 269 external reviews were filed in Florida against 17,515,496 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. 269 independent external reviews were filed in Florida against 17,515,496 denials, and 34.9% of them were overturned, Florida's own rows in the plan-year 2027 release of the CMS Transparency in Coverage file, read November 4, 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 65 calendar days from the date of its notice (CMS, 42 CFR 422.582(b)) and Medicaid managed care 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. 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 |
|---|---|---|---|
| Capital Health Plan | 96.2% | 448,953 | 0 |
| AvMed, Inc. | 24.7% | 181,070 | not reported |
| UnitedHealthcare of Florida, Inc. | 21% | 703,125 | 0 |
| AmeriHealth Caritas Florida, Inc. | 17.8% | 233,629 | 0 |
| Health First Commercial Plans, Inc. | 16.6% | 573,724 | 0 |
| Health Options, Inc. | 16.3% | 6,445,991 | not reported |
| Blue Cross and Blue Shield of Florida | 13.8% | 3,199,676 | 11 |
| Florida Health Care Plan, Inc. | 13.5% | 419,165 | 0 |
| Simply Healthcare Plans, Inc. | 11.5% | 18,893 | 0 |
| Centene Venture Company Florida | 9.8% | 5,291,270 | 258 |
| Community Care Network Inc | not reported | not reported | not reported |
| Oscar Health Maintenance Organization of Florida | not reported | not reported | not reported |
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Questions about appealing in Florida
What percentage of health insurance claims are denied in Florida?
13.5%, insurers in Florida denied 17,515,496 of 129,636,840 in-network claims across 12 reporting insurers, in the plan-year 2027 release of the CMS Transparency in Coverage Public Use File. The national rate in the plan-year 2027 release is 15.7%.
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?
269 external reviews were filed against 17,515,496 denials in Florida in the reported year, and 34.9% of those were overturned. Nationally, 22.2% (1,092 of 4,918; interval 22.2-23.8% for counts CMS withheld; 32.6% without SelectHealth) of external reviews are overturned and the decision is binding on the plan.
Which insurer in Florida denies the most?
By rate, Capital Health Plan at 96.2% of in-network claims (448,953 denied). 10 insurers in Florida report a denial rate; the lowest is Centene Venture Company Florida at 9.8%. 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 10 insurers with reported rates and they are not close to each other, that is the bit of this page we 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.
Axion Labs · hello@getaxionlabs.comThe Appeal Kit is the clock, yours and your plan’s, dated from your letter: $29 once.
The Florida figures on this page, 13.5%, 17,515,496 denials and 269 external reviews across 12 insurers, are the state’s own rows in the plan-year 2027 release, issued October 22, 2026. From the plan-year 2024 release to the plan-year 2026 release, external reviews filed went from 2,336 to 5,881. Overturned reviews went from 32.8% in the plan-year 2026 release to 22.2% in plan-year 2027, or from 32.6% to 32.6% without SelectHealth. We do not compare filed or overturned counts across plan-years 2026 and 2027. Some issuers may have counted pre-service appeals in their 2026 cells. 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 (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).