Question 1

How often does Capital Health Plan deny claims?

Accepted Answer

In 2024, Capital Health Plan denied 6.5% of in-network marketplace claims, per its CMS Transparency in Coverage filings.

Question 2

Do appeals of its denials succeed?

Accepted Answer

This page shows the appeal-overturn rate alongside the denial rate — a high overturn rate means many denials were reversed when customers pushed back.

Question 3

Where does this data come from?

Accepted Answer

CMS Transparency in Coverage machine-readable files, self-reported by the insurer. We compute in-network denial rates from the raw counts; see the Methodology page.

Capital Health Plan claim denials

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