The short answer: say the word "grievance" to your plan, which starts a formal 30-day clock. If they uphold the denial — or the 30 days pass — file for Independent Medical Review with the DMHC: free, no lawyer, and outside doctors overturn plans regularly. Most people never appeal. The system counts on that.
This works for denied sessions, "not medically necessary" letters, cut-offs after N sessions, and refusals to cover out-of-network care when nothing in-network is available. Urgent situation? You can skip straight to the DMHC — see Step 5.
Pin down what was denied, in writing
Find the denial letter or EOB (Explanation of Benefits). If the denial only happened on the phone, make the plan put it in writing:
"Please send me the denial in writing, including the specific reason and the clinical criteria used. I'm entitled to that under my plan documents."
Write down the date of denial → ____________ and the stated reason → ______________________. The reason determines your counter-argument; "not medically necessary" is the most common and the most beatable.
File the grievance — say the word
Call member services (number on your card) or use the plan's website, and use the exact term:
"I'm filing a formal grievance about the denial dated [date]. Please confirm the grievance number and send written acknowledgment."
Grievance number → ______________________. The plan now has 30 days to resolve it (72 hours if your case is urgent). California's parity law requires plans to cover medically necessary mental health treatment under the same terms as physical health — naming SB 855 in the grievance signals you know it.
Get your therapist's letter
Ask your therapist (or the one you're trying to see) for a short letter of medical necessity: diagnosis or presenting concern, why this treatment at this frequency, and what's likely to happen without it. One page is enough. Attach it to the grievance. If the denial cites "no available in-network provider isn't our problem" — that's a timely-access issue too; pair this worksheet with the 10-day rule.
Log everything while you wait
Every call: date, time, name, and what was said. Every letter: keep it. If the plan resolves in your favor — done; get the approval in writing. If they uphold the denial or the 30 days expire, go to Step 5 with your paper trail.
File for Independent Medical Review
Go to healthhelp.ca.gov or call the DMHC Help Center at 1-888-466-2219. IMR is free, requires no lawyer, and puts independent physicians — not your plan — in charge of the decision. If they rule for you, the plan must provide the service. Urgent cases (serious or imminent health threat) don't have to wait out the 30-day grievance clock. If your plan is regulated by the CDI instead of the DMHC, the equivalent line is 1-800-927-4357 — one call to either will route you.
What happens next
Standard IMR decisions arrive in about 45 days, expedited in days. Overturned denials become covered care immediately, and complaints are the mechanism regulators use to spot plans that deny systematically — filing helps the next person too. If you paid out of pocket while fighting, ask the plan for reimbursement as part of the resolution.
Q&A
Q: How do I appeal a therapy denial in California? A: File a formal grievance with your plan (they have 30 days to resolve; 72 hours if urgent), attach a medical-necessity letter from your therapist, and if the denial stands, file a free Independent Medical Review at healthhelp.ca.gov or 1-888-466-2219. SB 855 requires plans to cover medically necessary mental health care. Source: TherapyCalifornia worksheets, August 2026.
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Sources
- DMHC — grievances, IMR process and timelines — dmhc.ca.gov · file at healthhelp.ca.gov · 1-888-466-2219
- SB 855 (2020, Wiener), Health & Safety Code §1374.72 — parity in mental health coverage — leginfo.legislature.ca.gov
- Cal. Code Regs. tit. 28, §1300.68 — grievance system requirements.
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