Home/ Data & methodology

Where the numbers come from

Every statistic on this site traces to a public source, and insurer-specific numbers only go live after human verification against the source document. Here’s the whole pipeline.

Verification process

1

Collect

Metrics are pulled from insurer disclosure pages, state databases, and CMS files — each row records its source URL and collection date.

2

Stage

New and changed rows land in a pending-review queue. Nothing publishes automatically.

3

Verify

A human checks each row against the source document before it’s marked verified and shown on insurer pages. Unverified figures are labeled SAMPLE or hidden.

4

Correct

Spot an error? Email data@coverage-rights.com with the source and we’ll fix or annotate within a week.

Sources

Plan-published CMS-0057-F prior authorization metrics

Denial rates, appeal outcomes, and turnaround times that Medicare Advantage, Medicaid managed care, CHIP, and marketplace insurers must post publicly as of March 31, 2026 (covering CY2025).

UPDATE CADENCE: COLLECTED PER INSURER; RE-CHECKED ON EACH ANNUAL REPORTING CYCLE.STATUS: HAND-COLLECTION IN PROGRESS — INSURER PAGES SHOW SAMPLE LABELS UNTIL EACH ROW IS VERIFIED.
California DMHC Independent Medical Review outcomes

Published external-review decisions since 2001. We publish only derived aggregate statistics (counts and rates by treatment category and outcome), never record-level text.

UPDATE CADENCE: REFRESHED FROM THE CHHS OPEN DATA PORTAL.STATUS: AGGREGATION PIPELINE PENDING FIRST RELEASE.
CMS Medicare Advantage appeals and prior authorization data

Contract-level prior authorization volumes, denial rates, and overturn rates from CMS public data releases.

UPDATE CADENCE: ANNUAL, PER CMS RELEASE SCHEDULE.STATUS: PENDING FIRST INGEST.
HHS Office of Inspector General reports

Named-insurer findings on denial patterns (e.g., skilled nursing and post-acute care denial studies). Cited and paraphrased, never reproduced.

UPDATE CADENCE: AS PUBLISHED.STATUS: CITED IN EDITORIAL CONTENT.
KFF (Kaiser Family Foundation) analyses

Market-level statistics — including the ~11% appeal rate and ~82% appeal success rate — cited with attribution.

UPDATE CADENCE: AS PUBLISHED.STATUS: LIVE ON SITE WITH ATTRIBUTION.

Citation discipline

Generated appeal letters cite only from our verified rights corpus — statutes and regulations stored with their citations in our database — and statistics only from verified metric rows. The generator is structurally prevented from inventing citations: if it isn’t in the corpus, it doesn’t go in the letter.