California: Start Here
Beginner guide for California—Covered California, DMHC vs CDI, IMR external review, PA deadlines, and what to open next.
Read guideState playbook
California
State insurers, legislation, and appeal resources for patients and advocates in California.
4 guides
California Prior Authorization Law
5-day and 72-hour medical PA, Rx deemed approval, Knox-Keene standards, and Medi-Cal appeal basics.
Read guideCalifornia Health Insurance Appeals and Grievances
Grievances vs appeals, 30/3-day timelines, NAR, and path to Independent Medical Review.
Read guideCalifornia External Review (IMR)
DMHC and CDI Independent Medical Review—6-month filing, binding decisions, expedited and experimental paths.
Read guidePrior auth & internal appeals
Match the plan on the member ID card. Use the denial letter for where to file appeals.
- Kaiser Permanente
- Anthem Blue Cross (California)
- Blue Shield of California
- Health Net
- Molina Healthcare (California)
- LA Care Health Plan
- Medi-Cal managed care
External appeals
After internal appeal, for eligible California fully insured plans only.
- DMHC — Independent Medical Review (IMR)
- California Department of Insurance — IMR
- Medi-Cal fair hearing