FREE TO READ

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.

Claim Appeal Data
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For health plan policy and appeals leadership

What a health plan can and cannot learn from this record

There is no paid report for health plans. We built one and removed it, because the figure a plan would pay for is not in the public record, and what is in the record is already public. Here is what that record can and cannot say.

Three things the record cannot do

stated plainly

  • Give a plan its own overturn rate

    Health & Safety Code § 1374.33(g) commands removal of the plan’s name before independent medical review decisions are published. The decision file carries no plan identifier, so that figure cannot be produced from it by us or by anyone. Every plan already knows its own.

  • Rank plans

    The Department publishes enforcement actions but not enrolment beside them. A plan with more members has more opportunities to be sanctioned, so a raw count is confounded by size and is not a rate. Placing a named plan against the others would be a league table, and this project does not publish one.

  • Tell a plan its penalty exposure

    No California law ties penalties to overturn rates. SB 363 proposed a fine for a plan with 10 or more reviews in a year when more than half in a category are overturned; it was held in the Assembly Appropriations Committee under submission on 13 August 2026. Check its current status.

What the public record does hold

free

The market-wide picture: 65.2% of 11,573 decisions that reached external review in 2021-2025 ended with the reviewer not sustaining the denial, and that rate varies widely by treatment. It is on the findings page and every treatment page, free. The Department’s enforcement actions are published by the Department itself.

If a figure on this site is wrong, tell us and we will correct it. Everything here is restated from the Department’s published record, and a correction against that record gets priority review regardless of who asks. The corrections process · the neutrality commitment.

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