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Cardiovascular Procedures denials: what the review data shows
Independent reviewers have decided 505 published cases where an insurer denied cardiovascular procedures — and they overturned the insurer 52.1% of the time. If your denial is in this category, the odds say: appeal.
Published decisions
505
2001–2026
Overturned
52.1%
263 denials reversed
By denial reason
The excuse on the letter changes the odds — and the counter-strategy.
| Denial reason | Decisions | Overturned |
|---|---|---|
| experimental / investigational | 293 | 61.4% |
| medical necessity | 210 | 39% |
Within this category
Subcategories with at least 15 published decisions.
| Subcategory | Decisions | Overturned |
|---|---|---|
| Other | 311 | 49.2% |
| Surgery | 41 | 75.6% |
| Vein Ablation | 34 | 50% |
| Vein Stripping | 26 | 23.1% |
| Stent | 23 | 69.6% |
| Card Valve Repl | 23 | 73.9% |
| Pacemaker/Defib | 18 | 55.6% |
How to use this in your appeal
These are outcomes from California’s external review program — an independent physician panel that binds the insurer. Every state has an equivalent process, and internal appeals succeed even more often. Cite the category outcome when you appeal: reviewers routinely find that denials like yours didn’t hold up.
SOURCE: CALIFORNIA DMHC INDEPENDENT MEDICAL REVIEW OUTCOMES (CHHS OPEN DATA) · DERIVED AGGREGATE STATISTICS ONLY · METHODOLOGY
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.