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Rehab/ Svc - Outpt denials: what the review data shows
Independent reviewers have decided 1,384 published cases where an insurer denied rehab/ svc - outpt — and they overturned the insurer 54.9% of the time. If your denial is in this category, the odds say: appeal.
Published decisions
1,384
2001–2026
Overturned
54.9%
760 denials reversed
By denial reason
The excuse on the letter changes the odds — and the counter-strategy.
| Denial reason | Decisions | Overturned |
|---|---|---|
| medical necessity | 1,305 | 55.2% |
| experimental / investigational | 76 | 51.3% |
Within this category
Subcategories with at least 15 published decisions.
| Subcategory | Decisions | Overturned |
|---|---|---|
| Speech Therapy | 672 | 71.6% |
| Physical Therapy | 409 | 34% |
| Occupational Therapy | 161 | 55.9% |
| Other | 107 | 32.7% |
| Trau Brain Inj Prog | 16 | 43.8% |
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.