State coverage · all states
California publishes its external review decisions
Independent reviewers did not sustain the plan’s denial in 65.2% of 11,573 decisions in 2021-2025, and 52.5% of 42,621 since 2001.
Conditional on a denial having reached external review — what that changes.
What was found
verified 2026-09-04- External review process
- Run by the state.
- What is published
- Full decision database since 2001, with statutorily mandated case summaries; open-data CSV
- What that means
- The dataset behind this site. Health & Safety Code 1374.33(g) requires publication and commands removal of the plan's name before it happens.
What is true in every state. A federal right to an external review of most denials exists regardless of where you live, and your state’s insurance regulator or consumer-assistance program can tell you the route and the deadline for free. If your plan is a self-funded employer plan, that appeal goes to the federal process wherever you are — and that process publishes no decisions, so nothing here or anywhere describes its outcomes. Whether this covers you.
Free help in California. The DMHC Help Center files an Independent Medical Review at no cost — 1-888-466-2219, dmhc.ca.gov. It is the same review every number on this site describes.