{ "@context": "https://schema.org", "@type": "Dataset", "name": "Apellica Insurer Denial Report Cards", "description": "In-network claim denial rates, internal-appeal overturn rates and external-review outcomes for 194 marketplace issuer-state pairs in 32 HealthCare.gov states, plan years 2024 and 2025, derived without modification from the CMS Transparency in Coverage public use file.", "url": "https://apellica.com/insurer-denial-rates", "version": "1.0", "dateModified": "2026-09-11", "license": "https://creativecommons.org/licenses/by/4.0/", "isAccessibleForFree": true, "creator": { "@type": "Organization", "name": "Apellica", "url": "https://apellica.com" }, "isBasedOn": "https://data.healthcare.gov/dataset/230fcdc8-3a0b-48d5-98d9-36744a87906e", "citation": "Apellica (2026). Insurer Denial Report Cards: in-network claim denial and appeal overturn rates reported by marketplace issuers to CMS, plan years 2024 and 2025. v1.0, generated 2026-09-11. Derived from the CMS Transparency in Coverage PUF. CC-BY-4.0. https://apellica.com/insurer-denial-rates", "keywords": [ "health insurance", "claim denial rate", "appeal overturn rate", "ACA marketplace", "Transparency in Coverage" ], "spatialCoverage": "Alaska, Alabama, Arkansas, Arizona, Delaware, Florida, Georgia, Hawaii, Iowa, Illinois, Indiana, Kansas, Louisiana, Michigan, Missouri, Mississippi, Montana, North Carolina, North Dakota, Nebraska, New Hampshire, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Wisconsin, West Virginia, Wyoming", "temporalCoverage": "2022/2023", "variableMeasured": [ { "@type": "PropertyValue", "name": "in-network claim denial rate", "description": "in-network claims denied / in-network claims received, as reported by the issuer" }, { "@type": "PropertyValue", "name": "internal appeal overturn rate", "description": "internal appeals overturned / internal appeals filed" }, { "@type": "PropertyValue", "name": "external review overturn rate", "description": "external reviews overturned / external reviews filed" } ], "measurementTechnique": "Tabulation of issuer-reported counts from the CMS Transparency in Coverage PUF; stand-alone dental issuers removed; no estimation.", "distribution": [ { "@type": "DataDownload", "encodingFormat": "text/csv", "contentUrl": "https://apellica.com/insurer-denial-rates/data" }, { "@type": "DataDownload", "encodingFormat": "application/json", "contentUrl": "https://apellica.com/insurer-denial-rates/dataset.json" } ], "summary": { "issuer_state_pairs": 194, "latest_plan_year": 2025, "median_denial_rate_ranked_issuers": 0.18314999999999998, "pooled_denial_rate": 0.19700770305258927 }, "meta": { "generated_at": "2026-09-11", "source_name": "CMS Transparency in Coverage Public Use File (Health Insurance Exchange PUFs)", "source_url": "https://data.healthcare.gov/dataset/230fcdc8-3a0b-48d5-98d9-36744a87906e", "dictionary_url": "https://www.cms.gov/files/document/transparency-coverage-puf-datadictionary-py25.pdf", "puf_index_url": 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