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Everything here is free to read, and nothing here is a claim about your case. Built from California’s published records and modified by us — not official government data. How these numbers were made.

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Cited authority · 2021-2025 · California

American Heart Association

Independent medical reviewers in California named American Heart Association in 86 published decisions over 2021-2025. These are the disputes it turned up in.

47.7%

Overturned
41 of 86
Era
2021-2025
Jurisdiction
California DMHC IMR
41 overturned45 upheld

What this number is, and is not. It is the outcome of decisions in which the authority was named — not the effect of naming it. Reviewers cite the standard they applied, so the citation and the outcome share a cause. Read it as “disputes where this standard was the yardstick came out this way”, never as “citing this standard produces this result”.

These count only denials appealed all the way to independent review. Fewer than 1% of denials are appealed internally at all, so a share here is not the share of denials that are wrong — it is the share of contested ones reviewers did not sustain. California only, and only plans the state regulates: not self-funded employer plans, Medicare or Medicaid.

Free help. The California DMHC Help Center files an Independent Medical Review at no cost — 1-888-466-2219, dmhc.ca.gov. It is the same review these decisions came from, and you do not need us or a lawyer to reach it.

What stands out here

computed from this standard

  • against the market

    Decisions naming American Heart Association came out at 47.7%, 17 points below the 65.2% across all published decisions in this era. Reviewers reach for a standard when it settles the question, so the citation and the outcome share a cause.

  • where it is used

    It appears most in diagnostic imaging & screening disputes — 40 of the 86 decisions citing it, 47% of its whole footprint, at 22.5%.

  • the condition behind it

    The condition it is most often applied to is cardiac & circulatory (n=54, 61.1% overturned).

Treatment classes

computed
  • Diagnostic imaging & screening22.5%40
  • Durable medical equipment—18
  • Cardiovascular procedures—16
  • Pharmacy—10
  • Acute inpatient medical—1
  • General surgery—1

Condition classes

computed
  • Cardiac & circulatory61.1%54
  • Endocrine & metabolic—22
  • Prevention & wellness—3
  • Blood disorders—2
  • Cancer—2
  • Genetic disease—2