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Metastatic Breast Cancer: when insurers say no, reviewers often say yes
In 45 published external-review decisions involving metastatic breast cancer, independent physician reviewers overturned the insurer’s denial 46.7% of the time.
Published decisions
45
2001–2026
Overturned
46.7%
21 denials reversed
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 metastatic breast cancer 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.