The 2026 Insurance Denial Report

Overturn rate by denial type

Share of appealed denials overturned in the patient's favor. n = sample size per category.

Source: Apellica external-review outcomes dataset (n=73,987), 2026.

The appeal gap

Denials are common and appeals are rare. KFF found that HealthCare.gov insurers denied roughly 19% of in-network claims in 2024, yet consumers appealed fewer than 1% of those denials. Independent KFF data on appealed denials shows about 44% overturned, closely matching Apellica's 46.9%. The conclusion is the same from both datasets: appealing works far more often than people expect, and almost no one does it.

That gap is the story. Carriers can deny in volume because they know the overwhelming majority of denials are simply abandoned. A denial letter is a first answer, not the final word.

What a winning appeal contains

Across the overturned cases, the appeals that succeed share a structure: they quote the carrier's own denial reason, demand and then rebut the specific clinical criteria the plan applied, map the medical record to each criterion, and cite the controlling federal rule (29 CFR 2560.503-1 for employer plans, 45 CFR 147.136 for ACA plans). Generic letters that simply ask for reconsideration do not move reviewers; point-by-point rebuttals do.