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Oxygen denials: what the review data shows
Independent reviewers have decided 44 published cases where an insurer denied Oxygen — and they overturned the insurer 18.2% of the time. A denial for Oxygen is a starting position, not a final answer.
Published decisions
44
2001–2026
Overturned
18.2%
8 denials reversed
Conditions behind oxygen denials
What insurers denied — and how those fights ended.
| Category | Decisions | Overturned |
|---|---|---|
| COPD | 15 | 26.7% |
| Sleep Apnea | 4 | 0% |
Typical time to a decision
14 days
Most land between 8 and 21 days
Handled as urgent
25%
Expedited when a delay would cause harm
What the reviewers wrote
Excerpts from the independent reviewers’ published findings — the actual reasoning, quoted, not summarised.
Where the denial was overturned
Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for high-flow nasal cannula (HFNC) therapy (Airvo device and related supplies). Final Result: The reviewer determined that the requested device is medically necessary for the treatment of the patient's medical condition. Therefore, the Health Plan's denial should be overturned.On review of the available documentation, the requested HFNC therapy (Airvo device and related supplies) is supported as medically necessary for the treatment of this patient’s obstructive sleep apnea (OSA) and sleep-related hypoxia. The patient has been evaluated with at least two sleep studies, which have demonstrated an apnea/hypopnea index (AHI) of 43.6, and 70 events per hour. The patient has not been able to tolerate treatment with continuous positive airway pressure (CPAP).
Nature of Statutory Criteria/Case Summary: The patient requested authorization and coverage for a portable oxygen system in order to perform daily living activities outside the home for the treatment of chronic obstructive pulmonary disease.Ambulatory oxygen therapy refers to oxygen delivered during exercise or other activities of daily living. In order to determine if a patient requires home ambulatory oxygen therapy, ambulatory desaturation oximetry is required to determine the patient’s oxygen levels. Oxygen levels below 88% desaturation require supplemental oxygen. In addition to improving quality of life, portable oxygen therapy has been shown to improve oxygenation to the brain, allow for the ability to complete daily activities, and improve survival rates. In this case, the patient requires portable oxygen therapy due to her documented oxygen desaturation levels.
Where the denial was upheld
Worth reading too — these show what an appeal has to overcome.
Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for a portable oxygen concentrator. Venous blood gases should not be used as an indication for portable oxygen concentrators. Furthermore, the subsequent chest computed tomography (CT) and pulmonary function tests argue against many potential causes of true hypoxemia in this patient. While carbon monoxide levels can cause a falsely elevated oxygen level from a pulse oximeter, the patient’s Raynaud’s syndrome could also be causing a falsely low level on pulse oximetry. As such, for this particular patient, a pulse oximeter is not an adequate test to determine oxygen content in the blood.
Findings: The physician reviewer found that Nature of Statutory Criteria/Case Summary: The patient has requested authorization and coverage for Imogen G5 portable oxygen concentrator equipment. Based on the current evidence-based guidelines from the British Thoracic Society (BTS), this patient does not meet the criteria for treatment with ambulatory oxygen supplementation with the requested Imogen G5 portable oxygen concentrator equipment. Specifically, evaluation with CT of lung demonstrated resolution of the COVID-19 related original disease and no residual significant chronic pulmonary parenchymal disease. The patient’s Epworth Sleepiness Scale (ESS) score was recorded 2-6, which was below the cut-off of 10, indicating no excessive daytime somnolence.
Figures and quotations on this page come from 42,749 published decisions in the California DMHC Independent Medical Review dataset. These are California outcomes — every state runs an equivalent external review, but the rates here are California’s. Excerpts are quoted verbatim from the public record and describe this treatment generally, not any individual case.
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 outcome record for Oxygenwhen 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.