Insurance Guides
PlainInsurer guides explain how to read public NAIC complaint ratios, CMS claim-denial and prior-authorization filings, and ACA appeal columns, without shopping advice.
Each guide maps one registry question to the official columns behind it: what a 1.0 complaint ratio means, how marketplace denial rates are counted, how prior authorization shows up in CMS files, and how PlainInsurer's A-F grades are built from those same public sources. Use them to interpret a profile or ranking, not as personal insurance advice.
- Sources NAIC MCAS · CMS TiC · ACA appeal rules
- Guides 5
Practical guides to help you understand insurance data and protect your rights.
How to Read Insurance Complaint Ratios
What complaint ratios mean, how NAIC calculates them, and how elevated values are read within a line.
Prior Authorization: CMS Rules and Denial Rates
Why health and Medicare Advantage plans require prior authorization, and how PA denial rates appear in public data.
Claim Appeals Under ACA: Process Rules and CMS Columns
How the ACA internal-appeal and IRO external-review path is structured, plus CMS appeal-overturn columns.
Auto Insurance Complaint Data: What NAIC Columns Show
How NAIC auto-line complaint ratios describe claim-handling friction relative to market share.
How PlainInsurer's A-F Reputation Grades Work
What goes into the letter grade on every insurer profile, why it's relative not absolute, and what it can't tell you.
Methodology
Our guides are based on publicly available data from authoritative government sources. All statistics, ratings, and figures cited in these guides are drawn directly from official datasets and publications, with sources clearly referenced throughout.
We aim to present complex government data in plain language that is accessible to general audiences. When methodologies differ between data sources or change over time, we note these variations inline. Our editorial process includes regular reviews to ensure accuracy and timeliness of the information presented.
Download the registry extracts these guides explain: complaint-index.csv and marketplace-denial-rates.csv.
Why PlainInsurer Publishes Guides
The data on this site is faithful to the public record, but public records are rarely self-explanatory. Codes, categorical fields, thresholds, and regulatory terminology can confuse even frequent researchers. Our guides translate those specifics into plain English so that a non-expert reader can interpret a record page correctly and so that a professional reader can quickly confirm our interpretation. Guides are written by PlainInsurer, drafted by PlainInsurer for structure, and reviewed before publication to ensure that the underlying regulation, methodology, or historical context is represented accurately.
What You Will Find Here
Every guide focuses on a single, researchable question, usually something a visitor might type into a search engine. We cite the original source wherever we state a specific regulatory threshold, dollar figure, date, or fact-about-the-world. We do not invent numbers, do not quote unreliable secondary sources, and do not paraphrase source material so aggressively that its meaning shifts. If you notice a factual drift or a sentence where our summary disagrees with the linked source, email the correction and we will update the guide.
Guides Are Not Professional Advice
Reading a guide is a good first step, it orients you to the vocabulary, the process, and the known edge cases. It is not a substitute for talking to a licensed professional. Guides here do not establish a professional relationship, do not constitute advice tailored to your circumstances, and do not account for recent changes that may not yet be reflected in the upstream dataset. Use them to understand what you are looking at and to form better questions to bring to a qualified advisor.
How We Decide What to Write
We pick guide topics by looking at real visitor questions, search queries that land on the site without a good destination, emails from readers asking for explainers, and patterns in the data that deserve a sustained write-up. We favor topics where a short, honest, well-cited guide genuinely helps over topics that merely drive traffic. When we get a topic wrong, we correct it and note the update; when we get feedback that a guide missed an angle, we add a section rather than rewriting from scratch.