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Rsv: when insurers say no, reviewers often say yes
In 28 published external-review decisions involving rsv, independent physician reviewers overturned the insurer’s denial 75% of the time.
Published decisions
28
2001–2026
Overturned
75%
21 denials reversed
Most-fought treatments for rsv
What insurers denied — and how those fights ended.
| Treatment | Decisions | Overturned |
|---|---|---|
| Synagis | 22 | 68.2% |
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 rsv 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.