Home / Conditions / Substance Abuse
Substance Abuse: when insurers say no, reviewers often say yes
In 31 published external-review decisions involving substance abuse, independent physician reviewers overturned the insurer’s denial 22.6% of the time.
Published decisions
31
2001–2026
Overturned
22.6%
7 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 substance abuse 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.