California · 2021-2025 · 96 classes
Condition classes
What independent physician reviewers decided, by the condition the denied care was for. A class earns a page at 30 decisions in the most recent five complete years. Below that the decisions still exist in the dataset, but no page claims a rate for them.
The shape
24 broad classes24 classes, from post-surgical complications at 31.2% to endocrine & metabolic at 78.1%. Median class: 58.9%.
- Post-surgical complications31%
- Pregnancy/Childbirth32%
- Prevention & wellness37%
- Trauma & injuries46%
- Pediatrics47%
- Blood disorders51%
- Infectious disease52%
- Cardiac & circulatory53%
- Cancer53%
- Orthopedic & musculoskeletal55%
- Vision56%
- Genitourinary & kidney57%
- Respiratory59%
- Autism spectrum59%
- Genetic disease66%
- Dental67%
- Foot67%
- Immune disorders68%
- Ear, nose & throat70%
- Digestive & GI70%
- Skin70%
- CNS & neuromuscular71%
- Mental health75%
- Endocrine & metabolic78%
Find your class
by number of decisions- Overturned — the reviewer did not sustain the denial
- Upheld — the reviewer sustained the denial
- Endocrine & metabolic78.1%2,089
- Orthopedic & musculoskeletal55.3%1,987
- Mental health75.4%1,797
- CNS & neuromuscular70.7%925
- Cancer53.3%893
- Cardiac & circulatory52.7%586
- Digestive & GI69.9%519
- Skin70.1%448
- Genitourinary & kidney56.8%384
- Immune disorders67.6%346
- Autism spectrum59.4%303
- Pediatrics46.5%215
- Ear, nose & throat69.8%202
- Respiratory58.9%141
- Genetic disease66.4%134
- Infectious disease52.3%111
- Trauma & injuries46.2%104
- Vision55.8%77
- Foot67.1%73
- Prevention & wellness37.3%67
- Blood disorders50.9%57
- Pregnancy/Childbirth32.0%50
- Dental66.7%33
- Post-surgical complications31.2%32
Subcategories
72 of 72 carry a rateFiner detail, and the level most people search at. Fewer clear the threshold, which is the honest cost of not publishing a rate on a handful of decisions. Pair one with a condition to see what the record supports.
- Obesity87.6%1,287
- Osteoarthritis83.5%503
- Depression74.6%492
- Back Pain40.6%443
- Diabetes74.2%407
- Substance Use Disorder82.4%369
- Autistic Disorder59.5%296
- Knee Problem/Pain63.7%278
- Migraine82.5%211
- Prostate47.1%210
- Anxiety66.3%187
- Alcohol Use Disorder80.1%186
- Breast58.4%185
- Vertebral Disc Prob38.5%156
- Crohn's Disease82.8%134
- Apnea/Sleep Apnea77.1%118
- Psoriasis87.5%112
- ADHD62.6%107
- Arthritis61.0%100
- Short Stature39.0%100
- Sinusitis86.9%99
- Bipolar Disorder78.7%94
- Multiple Sclerosis85.9%92
- Dermatitis87.9%91
- Autoimmune Disease73.0%89
- High Cholesterol31.0%87
- Shoulder Problem/Pain44.6%83
- Ulcerative Colitis85.4%82
- Gender Dysphoria67.9%78
- Hormone Abnormality47.4%76
- Neck Problem/Pain50.0%74
- Arrhythmia/Irregular Heart Rhythm42.0%69
- GERD/Reflux Disease53.6%69
- PTSD75.4%69
- Not classified37.3%67
- Hypertension62.1%66
- Stroke/ CVA31.1%61
- Cardiac/Heart Prob45.8%59
- Female Breast Dis/Lump/Cyst53.4%58
- Eating Disorder85.7%56
- Alopecia87.3%55
- Peripheral Neuropathy63.6%55
- Excess Skin18.9%53
- Osteoporosis72.5%51
- Brain54.0%50
- Asthma65.3%49
- Hip Problem/Pain20.4%49
- Paralysis39.6%48
- Joint Problem/Pain50.0%46
- Lung63.0%46
- Thyroid Problems65.9%44
- Colon62.8%43
- Melanoma16.3%43
- Brain Injury/Concussion50.0%42
- Skin19.5%41
- Headache60.0%40
- Growth Horm Def56.4%39
- Irritable Bowel Syndrome69.2%39
- Lymphedema71.8%39
- Varicose Veins59.0%39
- Eczema89.5%38
- Bone Fracture/Break27.0%37
- Obsess/Compulsive81.1%37
- Schizophrenia83.8%37
- Lupus62.9%35
- Abdominal/Stomach Pain63.6%33
- Allergy6.1%33
- Bacterial Infection51.5%33
- Cerebral Palsy75.0%32
- Epilepsy90.3%31
- Breathing Problem63.3%30
- Coronary Artery Disease26.7%30
Every rate here counts only denials appealed all the way to independent review. Fewer than 1% of denials are appealed internally at all, so a share on this page is not the share of denials that are wrong — it is the share of contested ones that reviewers did not sustain. California only, and only plans the state regulates: not self-funded employer plans, Medicare or Medicaid.
Free help. The California DMHC Help Center files an Independent Medical Review at no cost — 1-888-466-2219, dmhc.ca.gov. You do not need us or a lawyer to reach it.