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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.
ConditionDecisionsOverturned
Breast Cancer213
95.3%
Dense Breasts60
96.7%
Medical Condition24
95.8%
Pregnancy18
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.

Denied Digital Breast Tomosynthesis? 94.8% got it reversed.

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