Insurer Denial Profile
insurer_denial_profileEverything reported for ONE named health insurer: claims received and denied in and out of network, the denial rate, and both internal and external appeal outcomes, for plan year 2026. Use when a caller names a company — "how often does Ambetter deny claims", "Blue Cross denial rate in Texas", "what happens if I appeal with Oscar". Matches on the insurer's name and is forgiving about punctuation, case and partial names; an issuer selling in several states returns one entry per state, since CMS reports these figures per issuer per state. Sourced from the CMS Transparency in Coverage Public Use File; covers HealthCare.gov states only.
Input Schema
| Name | Required | Description | Default |
|---|---|---|---|
| state | No | Optional two-letter state code to narrow a multi-state insurer, e.g. "TX". | |
| insurer | Yes | Insurer name or part of one, e.g. "Ambetter", "Blue Cross Blue Shield of Texas", "oscar". |