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Appeal outcomes, by treatment
When patients take a denial to independent review, the insurer’s decision gets thrown out far more often than people expect. Here’s the record for 42,749 published external-review decisions (2001–2026), by treatment category.
SOURCE: CALIFORNIA DMHC INDEPENDENT MEDICAL REVIEW OUTCOMES (CHHS OPEN DATA) · DERIVED AGGREGATES · METHODOLOGY
Decisions analyzed
43K
published reviews, 2001–2026
Overturned overall
52.5%
insurer denial reversed by reviewers
Overturn rate by treatment category
Click a category for the full breakdown — denial types, subcategories, and how to use the numbers in your appeal.
| Treatment | Decisions | Overturned on review |
|---|---|---|
| Prescription Drugs | 11,948 | 60.3% |
| Diagnostic Imaging & Screening | 5,994 | 48.5% |
| Mental Health Treatment | 4,835 | 59% |
| Durable Medical Equipment | 2,679 | 44.6% |
| Pain Management | 1,827 | 67.7% |
| Orthopedic Procedures | 1,676 | 29.4% |
| Cancer Care | 1,625 | 43.6% |
| General Surgery | 1,455 | 48.3% |
| Rehab/ Svc - Outpt | 1,384 | 54.9% |
| Reconstructive & Plastic Surgery | 1,310 | 45.6% |
| Electrical, Thermal & Radiofrequency Therapy | 1,115 | 43% |
| Autism-Related Treatment | 1,040 | 69.5% |
| Diag/ MD Eval | 776 | 47.7% |
| Emergency/Urg Care | 620 | 44.5% |
| Rehab/Svcs SNF Inpt | 521 | 24.6% |
| Cardiovascular Procedures | 505 | 52.1% |
| Specialty Procedures | 499 | 35.1% |
| Ear-Nose-Thro Proc | 490 | 51.4% |
| Alternative Tx | 414 | 33.6% |
| Inpatient Acute Medical Services | 341 | 49% |
| Ob-Gyn Proc | 292 | 43.8% |
| Neurosurgery Proc | 171 | 51.5% |
| Dent/Orthodont Proc | 168 | 55.4% |
| Chiropractic Care | 158 | 31.6% |
| Home Health Care | 153 | 47.1% |
| Vision Services | 113 | 42.5% |
| Urology Procedures | 105 | 41% |
| Surgery | 83 | 60.2% |
| Transportation | 65 | 53.8% |
| Ophthalmology Proc | 65 | 41.5% |
| Vision Services/Ophthalmology | 50 | 56% |
| Prev Health Screen | 44 | 27.3% |
| Drug Ad Oth Oral | 42 | 90.5% |
| Medicine Serv Proc | 34 | 52.9% |
MINIMUM 30 DECISIONS PER CATEGORY · OVERTURNED = REVIEWER REVERSED THE PLAN’S DENIAL