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Autism: when insurers say no, reviewers often say yes
In 1,009 published external-review decisions involving autism, independent physician reviewers overturned the insurer’s denial 64.8% of the time.
Published decisions
1,009
2001–2026
Overturned
64.8%
654 denials reversed
Most-fought treatments for autism
What insurers denied — and how those fights ended.
| Treatment | Decisions | Overturned |
|---|---|---|
| Speech Therapy | 238 | 73.9% |
| ABA Therapy | 113 | 65.5% |
| Occupational Therapy | 74 | 74.3% |
| ABA | 24 | 58.3% |
| Applied Behavioral Analysis Therapy | 24 | 79.2% |
| ABA | 18 | 44.4% |
| Applied Behavioral Analysis | 15 | 93.3% |
| Applied Behavioral Analysis | 15 | 66.7% |
| Residential Treatment Center | 13 | 84.6% |
| Cubby Bed | 12 | 91.7% |
| Direct Applied Behavioral Analysis Therapy | 12 | 100% |
How to use this in your appeal
These outcomes come from California’s external review program — an independent physician panel whose decision binds the insurer. Every state has an equivalent, and internal appeals succeed even more often. If your care for autism was denied, the published record says the denial is worth fighting.
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.