What Is an Independent Medical Review (IMR)?

An independent medical review (IMR) is an external evaluation of your insurance denial by physicians who are not affiliated with your insurance company. It's often your most powerful tool for overturning denials.

How IMR Works

  1. You request an external review after exhausting internal appeals
  2. Your case is assigned to an independent review organization (IRO)
  3. A physician in the relevant specialty reviews your case
  4. The reviewer examines medical records, plan terms, and clinical evidence
  5. A binding decision is issued (in most states, binding on the insurer)

When IMR Is Available

  • After one or two levels of internal appeal are exhausted
  • For medical necessity denials
  • For experimental/investigational treatment denials
  • When the insurer fails to respond to your appeal within deadlines
  • In some states, for urgent cases without exhausting internal appeals

IMR Success Rates

Independent medical reviews overturn insurance denials approximately 40-60% of the time, depending on the state and type of denial. This is significantly higher than internal appeal success rates.

How to Request

  1. Contact your state's department of insurance for the external review form
  2. Submit within the deadline (typically 4-6 months after final internal denial)
  3. Include all medical records, appeal letters, and denial notices
  4. Your treating physician's supporting statement is critical
  5. The review is typically free to you (cost borne by the insurer)

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Frequently Asked Questions

Is the IMR decision final?

In most states, the IMR decision is binding on the insurer — they must comply. However, you may still have the right to pursue further legal action. The insurer cannot appeal an IMR decision in most states.

How long does an IMR take?

Standard reviews must be completed within 45 days. Expedited reviews for urgent cases must be completed within 72 hours.

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