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Remicade denials: what the review data shows
Independent reviewers have decided 61 published cases where an insurer denied Remicade — and they overturned the insurer 65.6% of the time. A denial for Remicade is a starting position, not a final answer.
Published decisions
61
2001–2026
Overturned
65.6%
40 denials reversed
By condition
Published outcomes when Remicade was denied for these conditions.
| Condition | Decisions | Overturned |
|---|---|---|
| Crohn's Disease | 17 | 82.4% |
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 Remicadewhen 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.