Apellica Releases 50-State External Review Index, Documents 4.7x Spread in Insurance-Appeal Outcomes
Connecticut overturns 80 percent of denied insurance appeals at independent review; West Virginia overturns 17 percent. 27 states do not publish the statistic at all. Apellica's open dataset documents the spread.
NEW YORK — Apellica, an independent appeal-preparation service headquartered at One World Trade Center, today released the External Review Index, a 50-state open dataset of how often denied health-insurance claims are overturned at the final independent-review stage. The dataset, published under Creative Commons Attribution 4.0 at apellica.com/external-review-index, surfaces a 4.7x spread in outcomes that the federal appeal floor does not explain.
Connecticut overturns external-review denials at 80 percent. West Virginia overturns at 17 percent. The federally guaranteed appeal right these patients exercise is the same one, codified at 45 CFR 147.136. The gap is in state implementation, regulator engagement, and what each state has chosen to publish.
The 27-state information vacuum
Twenty-seven of fifty states do not publish a current external-review overturn statistic at all. Ohio's last legally mandated annual report came out in 2019. A patient asking what her odds are of winning an appeal in her state cannot get a defensible answer in more than half the country. Apellica flagged 33 cells in the dataset as data-gaps, naming the regulator and the last reporting year for each.
The full source for every numeric cell is published alongside the data, including a URL to the original state Department of Insurance annual report.
Why Connecticut's number is so high
Connecticut is the only state in the country whose Office of the Healthcare Advocate actively participates in external-review appeals on the patient's side. The advocate is appointed, funded by an assessment on regulated carriers, and statutorily empowered to help a patient prepare the appeal record. No other state has this. The Connecticut intervention is the closest thing to a replicable policy lever in the data.
States considering a similar structure have a working precedent. The Apellica index documents Connecticut's 2024-2025 overturn-rate trend alongside the staffing and assessment data published in the OHA's biennial report.
The dataset
The External Review Index covers all 50 states plus the District of Columbia plus the federal HHS-administered process that runs in six states without a state-approved IRO. Each row is one (state, year) cell. Every cell cites the underlying source document.
- License: Creative Commons Attribution 4.0 International — free to redistribute, free to modify, attribution required.
- Format: CSV plus a methodology PDF.
- Mirrors: Zenodo and GitHub, both linked from the landing page.
- Verification: any user with a laptop can re-derive the 80-vs-17 finding in roughly 20 minutes by clicking through to the named state DOI reports.
The index is the first in a sequence Apellica plans to release as state DOI annual reports for the 2025 plan year are published. Updates will be versioned at the same URL.
Who Apellica is
Apellica is an independent appeal-preparation service operating in all 50 states. It is not a law firm, not a medical provider, and not an insurance carrier. The company charges no upfront fee and bills a flat fee only on successful recovery. Apellica is headquartered at One World Trade Center, New York.
The firm's working guides and the External Review Index are intended for free public use by patients, advocates, state Department of Insurance staff, State Health Insurance Assistance Program counselors, and journalists. Citation is appreciated, not required.
What Apellica is asking journalists and regulators to do
The dataset is offered without restriction. Three uses that fit it cleanly:
- State regulators. If your state is one of the 23 currently publishing, the dataset documents how your reporting compares with peer states. If your state is one of the 27 currently silent, the named gap is a publishing decision that can change.
- Journalists. The 80-vs-17 finding is verifiable in roughly 20 minutes against the state DOI reports cited in the dataset. The Connecticut intervention is the replicable policy lever the rest of the story turns on.
- Patients and advocates. The state-by-state landing page shows the patient's local odds, the deadline, and the next-step portal for their state in plain language.
Contact
Apellica One World Trade Center New York, NY 10007
press@apellica.com +1 (888) 777-6120 apellica.com