Data on Appeals
-
Appeals in 2018
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2018: 718
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2018 Appeals: 400
- Number of Issuer Level External Appeals Filed in Calendar Year 2018: 15
- Number of Issuer Level External Appeals Overturned from Calendar Year 2018 Appeals: 8
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2018: 10,516
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2018 Appeals: 3,955
- Number of Issuer Level External Appeals Filed in Calendar Year 2018: 214
- Number of Issuer Level External Appeals Overturned from Calendar Year 2018 Appeals: 96
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2018: 146 Individual, 1 Small Business
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2018 Appeals: 95 Individual, 1 Small Business
- Number of Issuer Level External Appeals Filed in Calendar Year 2018: 8 Individual, 0 Small Business
- Number of Issuer Level External Appeals Overturned from Calendar Year 2018 Appeals: 1 Individual, 0 Small Business
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2018: 2,406 Individual, 626 Small Business
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2018 Appeals: 1,379 Individual, 314 Small Business
- Number of Issuer Level External Appeals Filed in Calendar Year 2018: 19 Individual, 0 Small Business
- Number of Issuer Level External Appeals Overturned from Calendar Year 2018 Appeals: 10 Individual, 0 Small Business
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2018: 1,214
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2018 Appeals: 1,105
- Number of Issuer Level External Appeals Filed in Calendar Year 2018: 13
- Number of Issuer Level External Appeals Overturned from Calendar Year 2018 Appeals: 2
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2018: N/A
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2018 Appeals: N/A
- Number of Issuer Level External Appeals Filed in Calendar Year 2018: N/A
- Number of Issuer Level External Appeals Overturned from Calendar Year 2018 Appeals: N/A
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2018: 160 Appeals (Clinical) 339 Appeals (Non-Clinical)
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2018 Appeals: 62 Appeals Overturned (Clinical) 43 Appeals Overturned (Non-Clinical)
- Number of Issuer Level External Appeals Filed in Calendar Year 2018: 12 Independent Medical Reviews (Clinical)
- Number of Issuer Level External Appeals Overturned from Calendar Year 2018 Appeals: 9 Independent Medical Reviews overturned (Clinical)
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2018: 218
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2018 Appeals: 79
- Number of Issuer Level External Appeals Filed in Calendar Year 2018: 6
- Number of Issuer Level External Appeals Overturned from Calendar Year 2018 Appeals: 2
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2018: 169
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2018 Appeals: 37
- Number of Issuer Level External Appeals Filed in Calendar Year 2018: 24
- Number of Issuer Level External Appeals Overturned from Calendar Year 2018 Appeals: 7
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2018: 157
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2018 Appeals: 31
- Number of Issuer Level External Appeals Filed in Calendar Year 2018: 29
- Number of Issuer Level External Appeals Overturned from Calendar Year 2018 Appeals: 12
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2018: 80
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2018 Appeals: 24
- Number of Issuer Level External Appeals Filed in Calendar Year 2018: 22
- Number of Issuer Level External Appeals Overturned from Calendar Year 2018 Appeals: 3
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Appeals in 2019
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2019: 423
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2019 Appeals: 338
- Number of Issuer Level External Appeals Filed in Calendar Year 2019: 4
- Number of Issuer Level External Appeals Overturned from Calendar Year 2019 Appeals: 1
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2019: 12,241 Individual, 219 Small Business
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2019 Appeals: 4,472 Individual, 7 Small Business
- Number of Issuer Level External Appeals Filed in Calendar Year 2019: 193 Individual, 7 Small Business
- Number of Issuer Level External Appeals Overturned from Calendar Year 2019 Appeals: 112 Individual, 3 Small Business
- Note: Blue Shield does not currently include the Date of Service in appeal reporting data
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2019: 171 Individual, 5 Small Business
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2019 Appeals: 114 Individual, 1 Small Business
- Number of Issuer Level External Appeals Filed in Calendar Year 2019: 6 Individual, 1 Small Business
- Number of Issuer Level External Appeals Overturned from Calendar Year 2019 Appeals: 2 Individual, 0 Small Business
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2019 Health Net Life: 2,132 Individual, 652
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2019 Health Net CA: 1,736 Individual
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2019 Health Net Small Business: 652
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2019 Appeals, Health Net Life: 997 Individual
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2019 Appeals, Health Net CA: 990 Individual
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2019 Appeals, Health Net Small Business: 305
- Number of Issuer Level External Appeals Filed in Calendar Year 2019, Health Net Life: 399 Individual
- Number of Issuer Level External Appeals Filed in Calendar Year 2019, Health Net CA: 363 Individual
- Number of Issuer Level External Appeals Filed in Calendar Year 2019, Health Net Small Business: 10
- Number of Issuer Level External Appeals Overturned from Calendar Year 2019 Appeals, Health Net Life: 2 Individual
- Number of Issuer Level External Appeals Overturned from Calendar Year 2019 Appeals, Health Net CA: 3 Individual
- Number of Issuer Level External Appeals Overturned from Calendar Year 2019 Appeals, Health Net Small Business: 0
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2019: 553
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2019 Appeals: 469
- Number of Issuer Level External Appeals Filed in Calendar Year 2019: 29
- Number of Issuer Level External Appeals Overturned from Calendar Year 2019 Appeals: 7
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2019: 6,632
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2019 Appeals: 2,375
- Number of Issuer Level External Appeals Filed in Calendar Year 2019: 4
- Number of Issuer Level External Appeals Overturned from Calendar Year 2019 Appeals: 3
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2019: 135 Appeals (Clinical), 327 Appeals (Non-Clinical)
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2019 Appeals: 54 Appeals Overturned (Clinical), 37 Appeals Overturned (Non-Clinical)
- Number of Issuer Level External Appeals Filed in Calendar Year 2019: 9 Independent Medical Reviews (Clinical)
- Number of Issuer Level External Appeals Overturned from Calendar Year 2019 Appeals: 6 Independent Medical Reviews overturned (Clinical)
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2019: 1,195
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2019 Appeals: 401
- Number of Issuer Level External Appeals Filed in Calendar Year 2019: 10
- Number of Issuer Level External Appeals Overturned from Calendar Year 2019 Appeals: 5
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2019: 108
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2019 Appeals: 32
- Number of Issuer Level External Appeals Filed in Calendar Year 2019: 22
- Number of Issuer Level External Appeals Overturned from Calendar Year 2019 Appeals: 1
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2019: 106
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2019 Appeals: 52
- Number of Issuer Level External Appeals Filed in Calendar Year 2019: 32
- Number of Issuer Level External Appeals Overturned from Calendar Year 2019 Appeals: 15
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2019: 73
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2019 Appeals: 24
- Number of Issuer Level External Appeals Filed in Calendar Year 2019: 4
- Number of Issuer Level External Appeals Overturned from Calendar Year 2019 Appeals: 1
-
Appeals in 2020
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2020: 862
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2020 : 505
- Number of Issuer Level External Appeals Filed in Calendar Year 2020: 18
- Number of Issuer Level External Appeals Overturned from Calendar Year 2020: 13
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2020: 219
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2020: 105
- Number of Issuer Level External Appeals Filed in Calendar Year 2020: 0
- Number of Issuer Level External Appeals Overturned from Calendar Year 2020: 0
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2020: 12,579 Individual, 294 Small Business
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2020: 4,213 Individual, 94 Small Business
- Number of Issuer Level External Appeals Filed in Calendar Year 2020: 220 Individual, 9 Small Business
- Number of Issuer Level External Appeals Overturned from Calendar Year 2020: 151 Individual, 8 Small Business
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2020: 73
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2020: 0
- Number of Issuer Level External Appeals Filed in Calendar Year 2020: 0
- Number of Issuer Level External Appeals Overturned from Calendar Year 2020: 0
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2020: Information to Come
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2020: Information to Come
- Number of Issuer Level External Appeals Filed in Calendar Year 2020: Information to Come
- Number of Issuer Level External Appeals Overturned from Calendar Year 2020: Information to Come
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2020: 166 Individual, 4 Small Business
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2020 Appeals: 65 Individual, 0 Small Business
- Number of Issuer Level External Appeals Filed in Calendar Year 2020: 20 Individual, 0 Small Business
- Number of Issuer Level External Appeals Overturned from Calendar Year 2020 Appeals: 13 Individual, 0 Small Business
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2020: 0
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2020: 0
- Number of Issuer Level External Appeals Filed in Calendar Year 2020: 0
- Number of Issuer Level External Appeals Overturned from Calendar Year 2020: 0
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2020, Health Net Life: 2,576 Individual
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2020, Health Net CA: 2,250 Individual
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2020, Health Net Small Business: 46
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2020 Health Net Life: 1,206 Individual
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2020, Health Net CA: 1,291 Individual
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2020, Health Net Small Business: 24
- Number of Issuer Level External Appeals Filed in Calendar Year 2020, Health Net Life: 323 Individual
- Number of Issuer Level External Appeals Filed in Calendar Year 2020, Health Net CA: 504 Individual
- Number of Issuer Level External Appeals Filed in Calendar Year 2020, Health Net Small Business: 0
- Number of Issuer Level External Appeals Overturned from Calendar Year 2020,Health Net Life: 6 Individual
- Number of Issuer Level External Appeals Overturned from Calendar Year 22020, Health Net CA: 5 Individual
- Number of Issuer Level External Appeals Overturned from Calendar Year 2020, Health Net Small Business: 0
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2020: 185
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2020: 61
- Number of Issuer Level External Appeals Filed in Calendar Year 2020: 1
- Number of Issuer Level External Appeals Overturned from Calendar Year 2020 : 1
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2020: 665
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2020: 402
- Number of Issuer Level External Appeals Filed in Calendar Year 2020: 9,051
- Number of Issuer Level External Appeals Overturned from Calendar Year 2020: 3,505
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2020: 15 Individual, 0 Small Business
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2020: 5 Individual, 0 Small Business
- Number of Issuer Level External Appeals Filed in Calendar Year 2020: 0 Individual, 0 Small Business
- Number of Issuer Level External Appeals Overturned from Calendar Year 2020: 0 Individual, Small Business
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2020: 540
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2020: 95
- Number of Issuer Level External Appeals Filed in Calendar Year 2020: 1
- Number of Issuer Level External Appeals Overturned from Calendar Year 2020: 1
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2020: 82
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2020: 79
- Number of Issuer Level External Appeals Filed in Calendar Year 2020: 10
- Number of Issuer Level External Appeals Overturned from Calendar Year 2020: 10
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2020: 109 Individual and Small Group; Pharmacy Individual; 75, Pharmacy Small Group 15
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2020: 30 Individual and Small Group; Pharmacy Individual; 42, Pharmacy Small Group 10
- Number of Issuer Level External Appeals Filed in Calendar Year 2020: 29 Individual and Small Group; Pharmacy Individual 0, Pharmacy Small Group 0
- Number of Issuer Level External Appeals Overturned from Calendar Year 2020: 12 Individual and Small Group; Pharmacy Individual 0, Pharmacy Small Group 0
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2020: 138
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2020: 58
- Number of Issuer Level External Appeals Filed in Calendar Year 2020: 12
- Number of Issuer Level External Appeals Overturned from Calendar Year 2020: 4
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2020: 99
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2020: 39
- Number of Issuer Level External Appeals Filed in Calendar Year 2020: 7
- Number of Issuer Level External Appeals Overturned from Calendar Year 2020: 1
-
Appeals in 2021
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2021: 875
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2021: 550
- Number of Issuer Level External Appeals Filed in Calendar Year 2021: 34
- Number of Issuer Level External Appeals Overturned from Calendar Year 2021: 27
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2021: 174
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2021: 79
- Number of Issuer Level External Appeals Filed in Calendar Year 2021: 0
- Number of Issuer Level External Appeals Overturned from Calendar Year 2021: 0
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2021: 11,481 Individual, 361 Small Business
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2021: 3,980 Individual, 125 Small Business
- Number of Issuer Level External Appeals Filed in Calendar Year 2021: 189 Individual, 12 Small Business
- Number of Issuer Level External Appeals Overturned from Calendar Year 2021: 120 Individual, 9 Small Business
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2021: 549
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2021: 174
- Number of Issuer Level External Appeals Filed in Calendar Year 2021: 0
- Number of Issuer Level External Appeals Overturned from Calendar Year 2021: 0
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2021: 354
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2021: 326
- Number of Issuer Level External Appeals Filed in Calendar Year 2021: 0
- Number of Issuer Level External Appeals Overturned from Calendar Year 2021: 0
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2021: 0
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2021: 0
- Number of Issuer Level External Appeals Filed in Calendar Year 2021: 0
- Number of Issuer Level External Appeals Overturned from Calendar Year 2021: 0
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2021: 1,769 Individual, 14 Small Business
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2021: 612 Individual, 5 Small Business
- Number of Issuer Level External Appeals Filed in Calendar Year 2021: 0 Individual, 0 Small Business
- Number of Issuer Level External Appeals Overturned from Calendar Year 2021: 0 Individual, 0 Small Business
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2021: 7 Individual, 0 Small Business
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2021: 4 Individual, 0 Small Business
- Number of Issuer Level External Appeals Filed in Calendar Year 2021: 0 Individual, 0 Small Business
- Number of Issuer Level External Appeals Overturned from Calendar Year 2021: 0 Individual, 0 Small Business
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2021: Health Net Life: 2,244 Individual, 50 Small Business
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2021: Health Net CA: 2,846 Individual
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2021: Health Net Life: 1,049 Individual, 26 Small Business
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2021: Health Net CA: 1.391 Individual
- Number of Issuer Level External Appeals Filed in Calendar Year 2021: Health Net Life: 202 Individual, 0 Small Business
- Number of Issuer Level External Appeals Filed in Calendar Year 2021: Health Net CA: 473 Individual
- Number of Issuer Level External Appeals Overturned from Calendar Year 2021: Health Net Life: 1 Individual, 0 Small Business
- Number of Issuer Level External Appeals Overturned from Calendar Year 2021: Health Net CA: 6 Individual
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2021: 226 Individual, 7 Small Business
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2021: 65 Individual, 2 Small Business
- Number of Issuer Level External Appeals Filed in Calendar Year 2021: 30 Individual, 0 Small Business
- Number of Issuer Level External Appeals Overturned from Calendar Year 2021: 15 Individual, 0 Small Business
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2021: 8,178
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2021: 2,721
- Number of Issuer Level External Appeals Filed in Calendar Year 2021: 4
- Number of Issuer Level External Appeals Overturned from Calendar Year 2021: 1
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2021: 631
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2021: 113
- Number of Issuer Level External Appeals Filed in Calendar Year 2021: 2
- Number of Issuer Level External Appeals Overturned from Calendar Year 2021: 0
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2021: 143
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2021: 128
- Number of Issuer Level External Appeals Filed in Calendar Year 2021: 21
- Number of Issuer Level External Appeals Overturned from Calendar Year 2021: 21
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2021: 133 Individual and 14 Small Group;
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2021: 75 Individual and 4 Small Group
- Number of Issuer Level External Appeals Filed in Calendar Year 2021: 0 Individual and 0 Small Group;
- Number of Issuer Level External Appeals Overturned from Calendar Year 2021: 0 Individual and 0 Small Group
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2021: 156
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2021: 70
- Number of Issuer Level External Appeals Filed in Calendar Year 2021: 18
- Number of Issuer Level External Appeals Overturned from Calendar Year 2021: 5
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2021: 82
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2021: 30
- Number of Issuer Level External Appeals Filed in Calendar Year 2021: 5
- Number of Issuer Level External Appeals Overturned from Calendar Year 2021: 2
-
Appeals in 2022
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2022: 2,029
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2022: 1,328
- Number of Issuer Level External Appeals Filed in Calendar Year 2022: 15
- Number of Issuer Level External Appeals Overturned from Calendar Year 2022: 12
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2022: 15
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2022: 6
- Number of Issuer Level External Appeals Filed in Calendar Year 2022: 0
- Number of Issuer Level External Appeals Overturned from Calendar Year 2022: 0
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2022: 14,585
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2022: 5,978
- Number of Issuer Level External Appeals Filed in Calendar Year 2022: 124
- Number of Issuer Level External Appeals Overturned from Calendar Year 2022: 71
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2022: 706
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2022: 312
- Number of Issuer Level External Appeals Filed in Calendar Year 2022: 4
- Number of Issuer Level External Appeals Overturned from Calendar Year 2022: 3
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2022: 1,021
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2022: 277
- Number of Issuer Level External Appeals Filed in Calendar Year 2022: 0
- Number of Issuer Level External Appeals Overturned from Calendar Year 2022:0
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2022: 174
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2022: 159
- Number of Issuer Level External Appeals Filed in Calendar Year 2022: 0
- Number of Issuer Level External Appeals Overturned from Calendar Year 2022: 0
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2022: 0
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2022: 0
- Number of Issuer Level External Appeals Filed in Calendar Year 2022: 0
- Number of Issuer Level External Appeals Overturned from Calendar Year 2022: 0
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2022: 0
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2022: 0
- Number of Issuer Level External Appeals Filed in Calendar Year 2022: 0
- Number of Issuer Level External Appeals Overturned from Calendar Year 2022: 0
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2022: 1,273
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2022: 483
- Number of Issuer Level External Appeals Filed in Calendar Year 2022: 0
- Number of Issuer Level External Appeals Overturned from Calendar Year 2022: 0
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2022: 2
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2022: 1
- Number of Issuer Level External Appeals Filed in Calendar Year 2022: 0
- Number of Issuer Level External Appeals Overturned from Calendar Year 2022: 0
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2022: 314
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2022: 66
- Number of Issuer Level External Appeals Filed in Calendar Year 2022: NA
- Number of Issuer Level External Appeals Overturned from Calendar Year 2022: NA
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2022: 989
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2022: 2,188
- Number of Issuer Level External Appeals Filed in Calendar Year 2022: 443
- Number of Issuer Level External Appeals Overturned from Calendar Year 2022: 15
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2022: 237
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2022: 89
- Number of Issuer Level External Appeals Filed in Calendar Year 2022: 22
- Number of Issuer Level External Appeals Overturned from Calendar Year 2022: 5
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2022: 17
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2022: 6
- Number of Issuer Level External Appeals Filed in Calendar Year 2022: 0
- Number of Issuer Level External Appeals Overturned from Calendar Year 2022: 0
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2022: 19,585
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2022: 10,820
- Number of Issuer Level External Appeals Filed in Calendar Year 2022: 8
- Number of Issuer Level External Appeals Overturned from Calendar Year 2022: 2
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2022: 535
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2022: 80
- Number of Issuer Level External Appeals Filed in Calendar Year 2022: 37
- Number of Issuer Level External Appeals Overturned from Calendar Year 2022: 7
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2022: 288
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2022: 152
- Number of Issuer Level External Appeals Filed in Calendar Year 2022: 15
- Number of Issuer Level External Appeals Overturned from Calendar Year 2022: 6
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2022: 13
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2022: 11
- Number of Issuer Level External Appeals Filed in Calendar Year 2022: 0
- Number of Issuer Level External Appeals Overturned from Calendar Year 2022: 0
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2022: 127
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2022: 89
- Number of Issuer Level External Appeals Filed in Calendar Year 2022: 7
- Number of Issuer Level External Appeals Overturned from Calendar Year 2022: 5
- Number of Issuer Level Internal Appeals Filed in Calendar Year 2022: 123
- Number of Issuer Level Internal Appeals Overturned from Calendar Year 2022: 60
- Number of Issuer Level External Appeals Filed in Calendar Year 2022: 8
- Number of Issuer Level External Appeals Overturned from Calendar Year 2022: 3
Anthem Blue Cross:
Blue Shield of California*:
*Blue Shield does not currently include the Date of Service in appeal reporting data
CCHP Health Plan:
Health Net:
Kaiser Permanente:
LA Care Health Plan:
Molina Healthcare:
Oscar:
Sharp Health Plan:
Valley Health Plan:
Western Health Advantage:
Anthem Blue Cross:
Individual Market:
Blue Shield of California*:
CCHP Health Plan:
Health Net:
Kaiser Permanente:
LA Care Health Plan:
Molina Healthcare:
Oscar:
Sharp Health Plan:
Valley Health Plan:
Western Health Advantage:
Anthem Blue Cross:
Individual Market:
Qualified Dental Plan:
Blue Shield of California*:
CCHP Health Plan:
California Dental Network:
Delta Dental:
Dental Health Services:
Health Net:
Kaiser Permanente:
LA Care Health Plan:
Liberty Dental Plan:
Molina Healthcare:
Oscar:
Sharp Health Plan:
Valley Health Plan:
Western Health Advantage:
Aetna CVSHealth:
2023 is this Issuer’s first year on Covered California, no data is available to report yet.
Anthem Blue Cross:
Individual Market:
Qualified Dental Plan:
Blue Shield of California:
Individual Market:
Qualified Dental Plan:
CCHP Health Plan:
California Dental Network:
Delta Dental:
Dental Health Services:
Health Net:
Kaiser Permanente:
LA Care Health Plan:
Molina Healthcare:
Oscar:
Sharp Health Plan:
Valley Health Plan:
Western Health Advantage:
Aetna CVSHealth:
2023 is this Issuer’s first year on Covered California, no data is available to report yet.
Anthem Blue Cross:
Individual Market:
Qualified Dental Plan:
Blue Shield of California:
Individual Market:
Small Business Market:
Qualified Dental Plan:
CCHP Health Plan:
Individual Market:
California Dental Network:
Individual Market:
Small Business Market:
Delta Dental:
Individual Market:
Small Business Market:
Dental Health Services:
Individual Market:
Health Net:
Individual Market:
Inland Empire Health Plan:
2024 is this Issuer’s first year on Covered California, no data is available to report yet.
Kaiser Permanente:
Individual Market:
Small Business Market:
LA Care Health Plan:
Individual Market:
Molina Healthcare:
Individual Market:
Sharp Health Plan:
Individual Market:
Small Business Market:
Valley Health Plan:
Individual Market:
Western Health Advantage:
Individual Market:
Appeals in 2023
Aetna CVSHealth:
Anthem Blue Cross:
Blue Shield of California:
Covered California for Small Business
CCHP Health Plan:
California Dental Network:
Delta Dental:
Covered California for Small Business
Health Net:
Kaiser Permanente:
Covered California for Small Business
LA Care Health Plan:
Molina Healthcare:
Sharp Health Plan:
Covered California for Small Business
Valley Health Plan:
Western Health Advantage:
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