Mental-health service
2,822 overturned · 1,966 upheld · n=4,788. Historical published decisions only.
Public records · not a prediction
California’s decisions, in plain language.
Official Independent Medical Review data shows what reviewers have decided across many cases. Enforcement records show what the regulator has required plans to correct. Neither tells you what will happen in your case.
Latest complete year · 2025
79%
309 of 389 published mental-health, substance-use, and autism IMR determinations were overturned. This is the state dataset’s historical count, not Parity’s success rate and not your odds.
What an IMR record can show
The behavioral-health file contains determinations since 2002 and classifies the requested service, diagnosis, denial reason, and result. It does not create binding precedent for another member, and aggregate categories can hide important differences in records and plan language.
Open the official California datasetFrequent service categories in the mental-health file
The diagnosis was behavioral; the denied service sometimes ranged wider, including pharmacy, equipment and procedures.
Autism-related treatment
698 overturned · 302 upheld · n=1,000. Historical published decisions only.
Pharmacy
223 overturned · 263 upheld · n=486. Historical published decisions only.
Electrical, thermal, or radiofrequency treatment
160 overturned · 138 upheld · n=298. Historical published decisions only.
Reconstructive or plastic procedure
212 overturned · 49 upheld · n=261. Historical published decisions only.
Outpatient rehabilitation service
92 overturned · 76 upheld · n=168. Historical published decisions only.
Source: California DMHC IMR determinations, published 2026-06-01, downloaded July 2, 2026.
The system has referees
Selected DMHC enforcement records
These are public agency actions, not celebrations and not proof that every complaint produces enforcement. They show the kinds of duties the regulator has enforced.
October 12, 2023 · $50 million fine
Kaiser Foundation Health Plan
DMHC's settlement addressed behavioral-health access, network and referral problems, oversight, parity, and grievances and appeals. It also required corrective work and monitoring.
Official enforcement recordApril 25, 2025 · $819,500 fine
Kaiser Foundation Health Plan
DMHC said Kaiser failed to timely process 61 member complaints, including late acknowledgments and late written grievance responses.
Official enforcement recordJanuary 30, 2026 · $15 million fine
Anthem Blue Cross
DMHC described longstanding and widespread failures in Anthem's member grievance system and required independent auditing of corrective work.
Official enforcement recordFree human help from DMHC
The DMHC Help Center has real people who help members at no charge. Confirm DMHC regulates your plan, then call 1-888-466-2219 or use the current official complaint route.
Open the DMHC Help CenterA postpartum access guide
A respectful, category-level guide to documenting an unavailable network and asking the plan for an actual route to care. It does not invoke a named family or tragedy.
Read the postpartum access playbook