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Crohn's Disease: when insurers say no, reviewers often say yes

In 287 published external-review decisions involving crohn's disease, independent physician reviewers overturned the insurer’s denial 65.2% of the time.

Published decisions
287
2001–2026
Overturned
65.2%
187 denials reversed

Most-fought treatments for crohn's disease

What insurers denied — and how those fights ended.
TreatmentDecisionsOverturned
Stelara40
97.5%
Humira18
77.8%
Remicade17
82.4%
Entyvio13
84.6%
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 crohn's disease 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.

Fighting a denial for crohn's disease? 65.2% won.

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