Coverage honesty
Does this cover you?
This page comes before any price, on purpose. A large share of people who find a site like this one are outside what this data can honestly describe, and it is better to say so here than to refund them later.
Who this does not cover
read this firstSelf-funded employer plans (ERISA)
Roughly half of Americans with employer coverage are in one. Those external appeals go to a federal process run by MAXIMUS Federal Services for the Department of Health and Human Services, which publishes no decisions and no outcome statistics. If your plan is self-funded, nobody in the country can tell you what reviewers decided in cases like yours, because nobody publishes them.
Texas, Florida and Georgia
Three of the ten largest insurance markets, and none of them runs a state external review process at all. Their appeals go into the same unpublished federal process. Texas does publish independent review decisions, but only for workers' compensation — a different system with different numbers, and blending the two would be fabricating.
Medicare and Medicaid
Separate appeal systems — administrative law judges, and state fair hearings — and out of scope here.
Most other states publish counts, not decisions
Illinois, Ohio, North Carolina, Michigan, Pennsylvania and New Jersey report annual totals. Useful context; not a dataset. Only California and New York publish decision-level reasoning, and New York is not yet included here.
What these numbers actually measure
applies even in CaliforniaExternal review is the end of a long funnel. Fewer than 1% of denials are appealed internally at all, and only a fraction of upheld internal appeals go on to external review. Every rate on this site is conditional on a denial having reached external review. It describes the denials that were fought to the end — a selected and informative population, not a census of denials.
What that means when you read a number. “65.2% overturned” does not mean 65.2% of denials are wrong. It means that among denials pursued all the way to an independent physician review, that share ended in the enrollee’s favour. Those are very different statements, and only the second one is supported here. The glossary sets out the difference in one paragraph, along with the three other terms that change how a number here reads.
Free help
listed first and lastCalifornia DMHC Help Center — 1-888-466-2219, dmhc.ca.gov. Files your Independent Medical Review at no cost. This is the same review these figures describe, and you do not need us, a lawyer or any paid service to reach it.
New York — Community Health Advocates, 1-888-614-5400.
Free appeal-letter tools exist and are worth knowing about. We do not draft letters and have no interest in steering you away from something that does.
Current scope
what is in the dataset today| Jurisdiction | California only |
| Years | 2001–2025 |
| Decisions | 42,621 analysable of 42,710 published |
| Headline era | 2021-2025 |
| Data as of | 2026-09-04 |
| New York | 52,327 decisions identified, not yet collected |
New York’s Department of Financial Services publishes external appeal decisions with summaries, named health plans and the medical literature relied on — a richer record than California’s in some respects. Its search endpoint is disallowed to automated access by the Department’s own robots.txt, so it is not collected here. A written request for a bulk export is outstanding. Methodology.