Methodology: Insurer Report Cards

Bursify publishes aggregate insurance-appeal outcomes to increase consumer transparency. The report-card numbers reflect outcomes for appeals filed through Bursify's insurance-appeals tool, not population-level claims statistics.

What the numbers mean

• Total cases: number of appeals in each (insurer × denial category × appeal level) bucket.
• Won: appeals overturned; coverage approved or payment issued.
• Lost: appeals upheld; coverage denial confirmed. Cases pending or awaiting response are not counted in “Won” or “Lost”.
• Win rate: Won ÷ (Won + Lost). Pending cases are excluded.
• Median days: median time from case creation to resolution, for resolved cases only.

K-anonymity

Rows with fewer than 10 cases are excluded from the public report cards to protect the privacy of individual users. An insurer + denial-category combination will not appear here until at least 10 users have had appeals in that bucket.

Denial categories

We normalize free-form denial reasons into 8 bounded categories using a deterministic classifier:

• not_medically_necessary
• experimental_investigational
• out_of_network
• pre_auth_not_obtained
• non_covered_benefit
• parity_violation_suspected: MH/SUD denials that show signs of a Parity Act violation
• coding_error
• other

Refresh cadence

Report cards are refreshed nightly at 02:00 UTC. The “last updated” timestamp on each page reflects the most recent refresh.

Limitations & disclaimers

• These are aggregate outcomes across Bursify users. Your individual outcome may differ.
• Not legal advice, not medical advice, not an endorsement or criticism of any insurer.
• Bursify uses RAG-grounded appeal letters with factual-accuracy validation; win rates reflect the full pipeline, not just the insurer's behavior.
• Historical outcomes do not guarantee future outcomes.