Why so few people appeal denied claims

KFF's analysis of federal transparency data on ACA Marketplace plans finds that insurers deny a meaningful share of in-network claims, while consumers appeal only a very small fraction of them.

Why it matters for advocates. Patients often don't know an appeal is possible, can't read the denial notice, or miss deadlines. Advocates can identify the plan type, request the claim file, organize evidence and keep track of dates.

Read the source before citing numbers — rates vary widely by insurer and year.

Sources: KFF, Claims denials and appeals in ACA Marketplace plans in 2024 (opens in a new tab); HealthCare.gov appeals (opens in a new tab).