Pennsylvania external-review reversal rate

48.4%

Reported for 2025 · State-reported

655 of 1,353 cases overturned in full or part.

Administered by Pennsylvania Insurance Department (PID). This is one cell of a 50-state public-record dataset; across measured jurisdictions the reported rate ranges from 17.0% (West Virginia) to 80.0% (Connecticut).

Read this number carefully

PA Independent External Review Program (launched 2024-01) referred 1353 eligible cases to IROs since inception through 2025; 655 overturned (~48%). First-year (2024) rate was 50.1%. Program is one of newest state-run replacements for HHS-administered process.

Denominators are not comparable between jurisdictions. Some states count cases received, some completed, some completed-and-eligible; some publish a complaint-process reversal rate broader than IRO-only external review. We reproduce the figure exactly as the jurisdiction published it and do not extrapolate.

Official sources

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Apellica (2026). The Apellica External Review Index — Pennsylvania. v1.0. Released 2026-05-19; resource updated 2026-09-04. CC-BY-4.0. https://apellica.com/external-review-index/pennsylvania

Spot an error in this figure or its source? Email editorial@apellica.com with the jurisdiction, the value you believe is correct, and a public-record URL. Apellica is an independent appeal-preparation service — not a regulator, law firm, or insurer — publishing this public regulatory data as a free research resource.