Before you appeal
What the record can tell you, free
California publishes every Independent Medical Review decision. This page gathers what that record says about a denial like yours. First, one question — because most people who find this site are not covered by it.
Answer both and this will tell you whether this covers your case. Your answers stay in this browser — nothing is sent anywhere.
The review costs you nothing. The DMHC Help Center — 1-888-466-2219 — files an Independent Medical Review at no charge. We once planned a paid kit for this moment and removed it, because no figure in this record changes whether a free appeal is worth filing. Everything below is free.
What the record says about a denial like yours
computed from the published recordWhere your kind of denial sits
71 treatment classes hold enough decisions to carry a rate. They run from 12.5% to 97.7% overturned, against 65.2% across every decision in 2021-2025. Find yours by treatment.
How the denial was characterised
A plan can deny a treatment as not medically necessary or as experimental. In the 11 classes where both are common enough to compare, medical-necessity disputes were overturned more often in 9, by 11.8 points on average. The classes.
What expedited review has meant
A median of 5 days to a decision, against 21 for standard review. 64.3% of expedited and 66.0% of standard reviews were overturned — different cases, so not the effect of asking. The Help Center can say whether yours qualifies.
Whether a figure you were quoted is current
35.1% of appealed denials were overturned in 2002; 72.4% in 2025. A number from an older report can be a long way from the current record. All the findings.
Where no rate is published
worth knowing firstAt the granularity a person actually asks at — this treatment, for this condition, on this kind of review — most combinations have fewer than 30 decisions behind them. With that few, a percentage swings by several points every time one case changes, so we show you the matching decisions and no percentage at all. Every count is shown as prominently as every rate.
What this is not
four things this is not- Not a prediction about your case. These figures describe groups of disputes that were already decided.
- Not a letter. Other services draft appeals, and one does it free.
- Not medical or legal advice. Your clinician, and where you choose your attorney, remain the decision-makers.
- Never anyone's medical history. Counts and cited guidelines only.
Read this before using any number here. Every figure counts only denials that reached external review. Fewer than 1% of denials are appealed at all, so a rate here is not the share of denials that are wrong. California only, and only plans the state regulates — not self-funded employer plans, Medicare or Medicaid. 42,621 decisions, data as of 2026-09-04.