Delays and denials of health coverage are troubling in a country that underperforms across many health outcomes, but how do coverage denials impose a broader set of administrative burdens? Though KFF analyses highlight the number of denied ACA marketplace claims that are appealed, this chapter offers the first survey evidence of appeals and reversals at the patient level. Such an analysis helps to unpack not only the number of appeals, but also who appeals, and to what extent the admininistrative burdens of appealing are inequitable. Drawing on survey evidence, interviews with patients, and administrative data, this chapter shows how few patients understand they can appeal, and often they underestimate the odds of prevailing against health insurance giants. What’s more, not only are less affluent patients less likely to challenge denials, but also Black and Hispanic Medicaid patients and sicker patients are less likely to appeal successfully. That appealing – and doing so successfully – is so inequitably distributed offers new insights into the scope of this health policy problem and how it can deepen racial and socioeconomic divides in access to health benefits.