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Digital Breast Tomosynthesis denials: what the review data shows
Independent reviewers have decided 367 published cases where an insurer denied Digital Breast Tomosynthesis — and they overturned the insurer 94.8% of the time. A denial for Digital Breast Tomosynthesis is a starting position, not a final answer.
Published decisions
367
2001–2026
Overturned
94.8%
348 denials reversed
By condition
Published outcomes when Digital Breast Tomosynthesis was denied for these conditions.
| Condition | Decisions | Overturned |
|---|---|---|
| Breast Cancer | 213 | 95.3% |
| Dense Breasts | 60 | 96.7% |
| Medical Condition | 24 | 95.8% |
| Pregnancy | 18 | 77.8% |
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 Digital 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.