What is an independent medical review (IMR)?

Any California managed care plan participant (whether on a private plan or Medi-Cal plan) may submit a request to the Department of Managed Health Care (DMHC) for a state-level independent medical review (IMR), aside from certain excluded county-run health systems.

An IMR may only be submitted after you have filed a grievance with your managed care plan and disagree with the outcome. You have 180 days (six months) from the date of the adverse grievance decision to request an IMR.

According to DHMC’s complaint website, an IMR is appropriate when a health plan “denies, changes, or delays your request for medical services, denies payment for emergency treatment or refuses to cover experimental or investigational treatment for a serious medical condition.”

You can learn more about how to submit one in our article Medi-Cal Appeals.