Insurer Appeal Outcomes
insurer_appeal_outcomesDoes appealing a denied health-insurance claim work? Marketplace issuers ranked by the share of appeals that were OVERTURNED in the patient's favour, plan year 2026. Answers "is it worth appealing a denied claim", "what percentage of insurance appeals succeed", "how often does reverse a denial", and which insurer most often changes its mind. Returns internal appeals (decided by the insurer itself) and external appeals (decided by an independent reviewer) separately, with how many were filed, how many were overturned, and the overturn percentage — the two differ a lot and the external number is the independent one. Sourced from the CMS Transparency in Coverage Public Use File; covers HealthCare.gov states only, so state-run exchanges such as California and New York are not present.
Input Schema
| Name | Required | Description | Default |
|---|---|---|---|
| limit | No | How many issuers to return (default 20, max 200). | |
| order | No | "highest" (default) ranks the most-overturned first; "lowest" ranks the least. | |
| state | No | Two-letter US state code to filter by, e.g. "TX". Omit for all states. | |
| market | No | Restrict to issuers participating in "medical" / "QHP", "dental" / "SADP", or "SHOP". Selects issuers rather than splitting their figures. Omit for all. | |
| appeal_type | No | "internal" (default, decided by the insurer) or "external" (decided by an independent reviewer). |