US claim denial — both appeal clocks and who to call
denial_clockOne call for a denied US health-insurance claim: both free appeal clocks with your actual dates where they can be computed, which external-review route applies (state, federal, or the federal one regardless of your state because the plan is self-funded), what the CMS file records for external reviews filed and overturned in that state and for that insurer — or 'not reported' where the file does not carry it — the insurer's own published appeal procedure where we have read it, and your state insurance department's consumer line with the date we read it from their own site. Use it at the second no as well, when the plan has said no again on internal appeal: external review is the step after it, and the CMS figures show how often that step overturned the insurer. Free, no key, attribution required. Source: CMS Transparency in Coverage Public Use File (PY2026 release), 45 CFR 147.136.
Input Schema
| Name | Required | Description | Default |
|---|---|---|---|
| state | No | US state name, slug or two-letter code. Decides the external-review route and the consumer line. | |
| insurer | No | Insurer slug or name — the free index is https://denialfacts.com/api/insurers. An unresolved value comes back named in `unresolved`, never as a 404. | |
| denial_date | No | Date on the denial notice, YYYY-MM-DD. Gives an actual internal-appeal deadline. The external-review deadline runs from the FINAL internal denial and is never derived from this date. | |
| self_funded | No | True if coverage is through a job and the employer pays the claims itself (a self-funded plan, 63% of covered workers). If true the state process does not apply whatever your state operates. |