Appeal outcomes

What independent reviewers actually decided — by procedure.

California publishes every independent medical review it decides. We read 7,459 of those decisions for the procedures a practice actually bills, and recorded not just how often the denial was overturned but which part of the record carried it.

How to read these

Independent medical review is the stage after a plan upholds its own denial. Every case here had already lost an internal appeal, which makes this a self-selected population — a rate says what happened to disputes like this at that stage, in one state, between 2017-2026. It is a base rate, not a prediction, and not medical or legal advice.

Injections

Laboratory

Imaging

Infused drugs

Surgery

Oncology

Therapy

Hospital & E/M

Home & equipment

Neuro

48 procedures are covered. The mined corpus holds more, but a procedure earns a page here only where a billed code routes to it — the rest are behavioral-health, retail-pharmacy, therapy-visit and durable-equipment categories where a practice arriving here would have a denial this tool cannot build a letter for.

Your denial, argued on what actually wins.

Merits reads the denied EOB and builds the appeal around the criteria a neutral reviewer credits — cited to the rule, the policy and the record.

Appeal a denial →