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California external review
Independent Medical Review (IMR)File within 180 days
California's IMR through the Department of Managed Health Care is one of the strongest external review systems in the country. It's free, you don't need a lawyer, and decisions bind your health plan. Roughly half of IMRs are decided in the patient's favor or result in the plan reversing itself.
Who to contact
CA Department of Managed Health Care (DMHC)1-888-466-2219
What to know
- File after your plan's internal appeal, or immediately for urgent cases.
- Applies to most HMO and many PPO members; CDI handles some PPO plans.
- Every IMR decision since 2001 is published — searchable precedent for your condition.
Not legal or medical advice. Coverage Rights is a self-help tool that helps you prepare your own appeal. For advice about your specific situation, talk to a licensed attorney or your doctor.