Data on Appeals

Appeals in 2018

Anthem Blue Cross:

  • 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

Blue Shield of California*:

  • 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

*Blue Shield does not currently include the Date of Service in appeal reporting data

CCHP Health Plan: Information to Come

Health Net:

  • 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

Kaiser Permanente: Information to Come

LA Care Health Plan:

  • 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

Molina Healthcare:

  • 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)

Oscar:

  • 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

Sharp Health Plan: Information to Come

Valley Health Plan:

  • 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

Western Health Advantage:

  • 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

Consumer Information

Quality Ratings

Claims

Data and Enrollment

Financial Information

Rate Booklet

Contracts