_{When cancer patients and doctors appeal insurance coverage denials through independent medical review (IMR), a formal external appeals process that provides binding decisions when patients and health plans dispute coverage, nearly one-third of those denials are overturned, according to a new multi-state study examining cancer genetic testing from 2019-2023 by Dr. Grace Lin, Dr. Janet Coffman, Michael Douglas, and Dr. Kathryn Phillips from the TRANSPERS Center at UCSF. Researchers pooled data from IMR databases in California, New York, Oregon, and Washington to better understand patterns in insurance coverage decisions for these increasingly important diagnostic tools. The research analyzed 941 cancer genetic testing cases across the four states, finding significant differences in how often denials were reversed depending on the state, type of cancer, and specific test involved. IMR data can reveal areas where plan coverage may be too restrictive or not consistent with clinical guidelines, offering a window into how payer policies align with evolving clinical practice and evidence.}