The Independent Medical Review Program

4 The First Step – Notification You or any person you have designated may request an IMR if you disagree with a health insurer’s decision regarding a disputed health care service that has been determined not to be medically necessary or has been denied as experimental or investigational. Your insurance company is required to send you an IMR application with its denial letter. If you do not receive an application from your insurance company, you can request one from the CDI by calling 1-800-927-4357 or visiting the CDI website at www.insurance.ca.gov The Second Step- The Agreement Since making a request for an IMR is voluntary, you must give the CDI written consent indicating that you wish to participate in the IMR program. The application form includes a consent statement which when signed gives your permission to obtain any necessary medical records in order to proceed with the IMR. The Third Step - Eligibility When your completed application with any additional information is received, the CDI will determine if your request qualifies for the IMR program. If your request does qualify, you will be notified. If your request does not qualify for the IMR program, then your claims review request will be referred to the complaint/mediation program within the CDI. How does the Independent Medical Review program work?