Data and Decisions
The state publishes every determination. Here is what that public record shows.
Find my next step (Opening soon)Complete years since SB 855 · By year
2026 shown after the year completes.Complete post-2021 years available in this dataset are compared below.
This is a historical aggregate, not a prediction for any individual case.
Every complete year shown is above the 59% rate for all years on record. The rates vary from year to year.
Mental-health IMRs · 2025, most recent complete year
When a mental-health or substance-use denial reaches California's Independent Medical Review, an independent panel decides whether the plan was right.
of mental-health IMRs decided in 2025 favored the member: 309 of 389 decisions, in the state's own data.
You can ask DMHC to review this. DMHC decides whether each issue belongs in IMR or the complaint process. In California's 2025 data, 309 of 389 mental-health IMR determinations favored the member (79%). Historical data, not a prediction for your case. See the data
These counts include only published cases that reached a determination. They do not count matters resolved before a published IMR decision, and they do not estimate the probability of coverage in any individual case.
2025, mental-health IMRs, n=389. Mental-health categories only (mental disorder, autism spectrum, and mental/behavioral/neurological), 2025 determinations. This is a historical aggregate, not a prediction for any individual case.
California Open Data, DMHC Independent Medical Review Determinations, 2025, mental health, autism spectrum, and mental/behavioral/neurological categories. Baseline IMR data, not a Parity outcome.
2002–present, behavioral-health IMRs, n=7,571
59% across all years on record (2002–present): across all 7,571 behavioral-health IMR determinations. That includes every case with a mental-health, autism-spectrum, or mental/behavioral/neurological diagnosis, whatever service was denied. 4,435 were overturned and 3,136 upheld, so 59% went the patient's way. Recent years run well above the all-time average: SB 855, California's strengthened parity law, took effect in 2021, and 2025 is the strongest year on record. Same CalHHS DMHC IMR dataset as below (the “By treatment” section further down slices the same cases by the denied service instead of the diagnosis).
By type
Medical Necessity
60%
2002–present, behavioral-health IMRs · Medical Necessity · overturned · n=7,044
Experimental/Investigational
35%
2002–present, behavioral-health IMRs · Experimental/Investigational · overturned · n=446
Urgent Care
28%
2002–present, behavioral-health IMRs · Urgent Care · overturned · n=81
By treatment
All behavioral-health years in the file (2002–present), the same cases as above but grouped by the denied service instead of the patient's diagnosis: every service category inside the behavioral-health IMR dataset with at least 20 determinations (the diagnosis was behavioral; the denied service sometimes ranged wider, including pharmacy, equipment and procedures), highest overturn rate first. Because this cut is by service, the “Mental Health” row here (n=4,788) is narrower than the 7,571 determinations above. The two happening to round to the same 59% is a coincidence, not one figure disagreeing with itself.
The clock
Standard review
21 days
Historical median · 2002–present, behavioral-health IMRs · Standard review · n=4,895
Expedited (urgent) review
5 days
Historical median · 2002–present, behavioral-health IMRs · Expedited (urgent) review · n=2,676
Who regulates what
The DMHC and the CDI oversee different kinds of state-regulated coverage. Medi-Cal, Medicare, private-employer plans, and federal programs can use other help or review processes. This is a list of common routes, not every possible program.
You can start with Path Finder for a likely route to check →(Opening soon). Your notice and plan documents control the current instructions.
Decisions and enforcement
Official Independent Medical Review data shows what reviewers have decided across many cases. Enforcement records show what the regulator has required plans to correct. Neither tells you what will happen in your case.
The behavioral-health file contains determinations since 2002 and classifies the requested service, diagnosis, denial reason, and result. It does not create binding precedent for another member, and aggregate categories can hide important differences in records and plan language.
Open the official California datasetThe system has referees
These official actions show conduct the regulator investigated and required plans to correct. They are not proof that every complaint leads to a fine, and they do not predict an individual result.
October 12, 2023 · $50 million fine
DMHC's settlement addressed behavioral-health access, network and referral problems, oversight, parity, and grievances and appeals. It also required corrective work and monitoring.
Open the official DMHC recordApril 25, 2025 · $819,500 fine
DMHC said Kaiser failed to timely process 61 member complaints, including late acknowledgments and late written grievance responses.
Open the official DMHC recordJanuary 30, 2026 · $15 million fine
DMHC described longstanding and widespread failures in Anthem's member grievance system and required independent auditing of corrective work.
Open the official DMHC recordHow denials affect people
A denial doesn’t end with the paperwork. Coverage decisions affect whether people can start care, stay in care, and afford the care they already received. Read sourced reporting and official California accountability records.
KFF
KFF found that 18% of insured adults reported a denied claim in the prior year. Among people whose insurance problems included a denied claim, 69% did not know whether they had appeal rights.
National survey, not a California-only measure and not limited to mental-health denials.
Read the sourceCalifornia Department of Managed Health Care
DMHC’s behavioral-health investigations review plan compliance with parity requirements, utilization management, medical-necessity definitions, and access to care.
Official California oversight material; it does not predict any individual complaint or appeal.
Read the sourceNeed help with your own plan?
If DMHC regulates your plan, its Help Center has real people who help members at no charge. Confirm DMHC regulates your plan, then call 1-888-466-2219 or use the current official complaint route. Confirm your regulator before relying on a route or deadline.
Open the DMHC Help CenterWant policy to change?
California’s official lookup can identify your Assemblymember and state Senator by address. Tell them what happened, what you want changed, and whether their office may contact you. Do not send medical records or member IDs through an ordinary public contact form.
Find my California representativesThis is civic participation, not a filing route, legal advice, or a substitute for a plan appeal or regulator complaint.
A practical guide
A guide to documenting an unavailable network and asking the plan for an actual route to care.
Read the postpartum access playbook(Opening soon)Source and method
Source: CalHHS Open Data Portal, DMHC Independent Medical Review Determinations (all conditions, 2001–present; the behavioral-health cases start in 2002). We downloaded the full public dataset (42,749 determinations across all conditions) and filtered to the behavioral-health diagnosis categories: Mental Disorder, Autism Spectrum, Mental Behav Neur (7,571 determinations). Overturn rate is the share of those cases decided "Overturned Decision of Health Plan" out of all overturned-or-upheld determinations.
An important honest caveat: these are historical aggregates. Outcomes vary case by case, and a past overturn rate is not a prediction or a guarantee for any individual appeal. The dataset contains no insurer or health-plan field, so no plan-specific figures can be derived from it, and none are shown here.
Published 2026-06-01. Downloaded July 2, 2026; verified weekly.
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