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:

• 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

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:

• 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

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:

• 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

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

• Appeals in 2019

Anthem Blue Cross:

Individual Market:

• 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

Blue Shield of California*:

• 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

CCHP Health Plan:

• 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

Health Net:

• 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

Kaiser Permanente:

• 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

LA Care Health Plan:

• 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

Molina Healthcare:

• 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)

Oscar:

• 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

Sharp Health Plan:

• 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

Valley Health Plan:

• 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

Western Health Advantage:

• 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

Anthem Blue Cross:

Individual Market:

• 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

Qualified Dental Plan:

• 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

Blue Shield of California*:

• 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

CCHP Health Plan:

• 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

California Dental Network:

• 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

Delta Dental:

• 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

Dental Health Services:

• 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

Health Net:

• 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

Kaiser Permanente:

• 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

LA Care Health Plan:

• 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

Liberty Dental Plan:

• 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

Molina Healthcare:

• 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

Oscar:

• 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

Sharp Health Plan:

• 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

Valley Health Plan:

• 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

Western Health Advantage:

• 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

Aetna CVSHealth:

2023 is this Issuer’s first year on Covered California, no data is available to report yet.

Anthem Blue Cross:

Individual Market:

• 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

Qualified Dental Plan:

• 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

Blue Shield of California:

Individual Market:

• 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

Qualified Dental Plan:

• 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

CCHP Health Plan:

• 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

California Dental Network:

• 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

Delta Dental:

• 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

Dental Health Services:

• 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

Health Net:

• 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

Kaiser Permanente:

• 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

LA Care Health Plan:

• 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

Molina Healthcare:

• 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

Oscar:

• 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

Sharp Health Plan:

• 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

Valley Health Plan:

• 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

Western Health Advantage:

• 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

Aetna CVSHealth:

2023 is this Issuer’s first year on Covered California, no data is available to report yet.

Anthem Blue Cross:

Individual Market:

• 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

Qualified Dental Plan:

• 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

Blue Shield of California:

Individual Market:

• 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

Small Business Market:

• 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

Qualified Dental Plan:

• 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

CCHP Health Plan:

Individual Market:

• 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

California Dental Network:

Individual Market:

• 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

Small Business Market:

• 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

Delta Dental:

Individual Market:

• 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

Small Business Market:

• 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

Dental Health Services:

Individual Market:

• 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

Health Net:

Individual Market:

• 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

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:

• 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

Small Business Market:

• 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

LA Care Health Plan:

Individual Market:

• 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

Molina Healthcare:

Individual Market:

• 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

Sharp Health Plan:

Individual Market:

• 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

Small Business Market:

• 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

Valley Health Plan:

Individual Market:

• 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

Western Health Advantage:

Individual Market:

• 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