Search what independent reviewers wrote

Type a drug, procedure or phrase. Results are fragments of the reviewer’s findings from California IMR decisions, with the decision and year.

Enter at least three characters.

Browse by treatment instead: Appeal Outcomes Library. Overall, reviewers overturned about half of all decisions in the dataset; see each treatment’s page for its rate.

Read these numbers carefully

California only: these are decisions by independent reviewers under California's IMR program (plans regulated by the Department of Managed Health Care). Other states and self-funded employer plans use different reviewers and rules.
Selection: only denials that a member took all the way to IMR appear. Most denials are never appealed, and the ones that reach an external reviewer are not a random sample.
Overturned means the reviewer disagreed with the plan; it does not mean the treatment worked or that a similar request will be approved.
Argument tags are keyword matches on the reviewer's findings. They describe what the findings mention, not why the case was decided.
Categories are DMHC's own labels (treatment sub-category and diagnosis category); 'Other' is a catch-all and is excluded from rankings.

Source: California Department of Managed Health Care, Independent Medical Review (IMR) Determinations, Trend (CHHS Open Data). Public California government data; Apellica's aggregates and tags are CC BY 4.0.