California Department of Managed Health Care – Independent Medical Review (IMR)
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California Department of Managed Health Care – Independent Medical Review (IMR)


California has the strongest patient’s right laws in the nation. The California Department of Managed Health Care’s Help Center can help ensure you get the care you are entitled to. What do I do if my health plan denies care that I need? The Department of Managed Health Care’s Help Center can provide an Independent Medical Review. Independent doctors from outside your health plan will review your case. If these doctors decide in your favor, your health plan must give you the service or treatment you requested. An independent review is free, regardless of outcome. Nearly 60 percent of these cases result in the patient receiving the requested care. You may qualify for an independent medical review if: Your plan denies the care you need, and says that it is not necessary or is experimental. Your plan won’t pay for emergency care that you have already received. How long does an independent medical review take? If your health problem is urgent an independent medical review is usually decided within 3-7 days. This is called an expedited independent medical review. Your doctor must provide written documentation that your health problem is urgent. If your health problem is not urgent, an independent medical review is usually decided within 30 days. At the Help Center your privacy is safe, we keep names, personal and medical information strictly confidential. For more information or to request an Independent Medical Review contact the Department of Managed Health Care’s Help Center at 1-888-466-2219 or visit us online at www.HealthHelp.ca.gov

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