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Breast Tomosynthesis denials: what the review data shows
Independent reviewers have decided 336 published cases where an insurer denied Breast Tomosynthesis — and they overturned the insurer 93.2% of the time. A denial for Breast Tomosynthesis is a starting position, not a final answer.
Published decisions
336
2001–2026
Overturned
93.2%
313 denials reversed
By condition
Published outcomes when Breast Tomosynthesis was denied for these conditions.
| Condition | Decisions | Overturned |
|---|---|---|
| Pregnancy | 82 | 92.7% |
| Medical Condition | 80 | 96.2% |
| Breast Cancer | 75 | 92% |
| Dense Breasts | 37 | 91.9% |
| Cancer | 28 | 92.9% |
How to use this in your appeal
These are outcomes from California’s external review program — an independent physician panel that binds the insurer. Every state has an equivalent process, and internal appeals succeed even more often. Cite the outcome record for Breast Tomosynthesiswhen you appeal: reviewers routinely find that denials like yours didn’t hold up.
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.