Where does this denial rate data come from?+
The denial rate data is sourced from CMS Transparency in Coverage filings and state insurance department reports. Insurers are required to publicly disclose claims processing metrics under the Affordable Care Act and related regulations. We compile and present this data for consumer awareness.
What counts as a "denied" claim?+
A denied claim is any claim submitted to an insurer that is not approved for payment. This includes claims denied for medical necessity, out-of-network care, prior authorization failures, coding errors, and administrative reasons. It does not include claims that are pended (held for more information) but eventually paid.
Can I appeal a denied insurance claim?+
Yes. Under the ACA, you have the right to an internal appeal with your insurer and, if that fails, an independent external review. Studies show that ~60% of appealed denials are overturned. The key is writing a strong appeal that cites the specific plan language, medical evidence, and regulations that support your claim.