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