External review in California: deadline, cost and how to ask
California runs its own independent review of denials: Independent Medical Review (IMR). You generally have 6 months to ask for it.
External review means a doctor or reviewer outside your plan decides again. Internal appeal means your plan looks at its own decision again.
Checked against official sources: October 30, 2026.
Appeal deadlines are strict. If you are near a deadline or your care is urgent, call free help today.
Step 2: Outside review in California
- Program
Independent Medical Review (IMR)
- Who runs it
- Department of Managed Health Care (DMHC): Health care service plans (HMOs and other DMHC-regulated plans, including Medi-Cal managed care plans regulated by the DMHC)
- Department of Insurance (CDI): Health insurance policies
- Deadline to ask
6 months
You can apply within 6 months. The agency may allow more time if your circumstances warrant it.
- The deadline runs from
The plan's or insurer's final grievance decision (or the end of 30 days with no decision)
- Do I have to appeal to my plan first?
File a grievance with your plan or insurer first. You can apply for IMR once the plan upholds the denial, or once 30 days have passed without a decision (3 days for an urgent grievance). In extraordinary and compelling cases the DMHC may waive the grievance step.
- When you can go without a plan answer
30 days after you file your internal appeal; 3 days for an urgent appeal
- How long the review takes
Standard: 30 days; Urgent: 3 days
- Cost
IMR is free. You pay no application or processing fees.
- What can be reviewed
Care that was denied, changed or delayed because the plan or insurer said it was not medically necessary; denials of experimental or investigational treatment; and claims for urgent or emergency care that were denied as not medically necessary. Coverage disputes (whether a service is covered under your contract at all) are not decided by IMR; the DMHC handles those as a complaint.
- Is the decision final?
The IMR decision is binding on the plan or insurer.
- How to ask
For an insurance policy, apply to the CDI online or with the CDI IMR application and attach your insurance card and letters and Explanation of Benefits. For a DMHC-regulated plan, apply to the DMHC: the plan must send you a DMHC IMR application form and an addressed envelope with its grievance decision. You can name someone to help you, and your doctor can join your request.
Law: Cal. Health & Safety Code 1374.30-1374.36; Cal. Ins. Code 10169-10169.5
Source: form CSD-003-IMR
- Forms and online request
- Phone
DMHC 1-888-466-2219; CDI 1-800-927-4357
Write my appeal: free letters
Sources
The official sources for California are listed on the California page.