Condition class · subcategory · California
Cerebral Palsy denials at external review
When a California health plan denied care for cerebral palsy and the enrollee took it to Independent Medical Review, this is what independent physician reviewers decided.
75.0%
- Overturned
- 24 of 32
- Era
- 2021-2025
- Jurisdiction
- California DMHC IMR
- Published class
- Cerebral Palsy
- Median days to decision
- 43
- All years
- 57.5% of 146
By treatment
computed- Overturned — the reviewer did not sustain the denial
- Upheld — the reviewer sustained the denial
- Durable medical equipment—19
- Orthopedic procedures—2
- Pain Management—2
- Outpatient rehabilitation—2
- Alternative treatment—1
- Diagnostic imaging & screening—1
- Diagnostic & physician evaluation—1
- Home Health Care—1
The specific treatments inside this class
below n=30, no rate is claimed- Other—12
- Wheelchair—4
- Special Bed—3
- Electric Wheelchair—2
- Viscosupp Injection—2
- Hyperbaric O2 Chamb—1
- Incontinence Supplies—1
- Physical Therapy—1
By review type
computed- Medical Necessity—27
- Experimental/Investigational—5
Medical-necessity review asks whether the care is needed. Experimental/investigational review asks whether it is likely to be more beneficial than standard therapy — a harder statutory test, and the rates show it.
Every figure on this page is conditional on a denial having reached external review. Fewer than 1% of denials are appealed internally at all, so this describes denials that were fought to the end — not denials in general — and it describes California only. Who this does not cover.
Free help, first: the California DMHC Help Center files your Independent Medical Review at no cost — 1-888-466-2219, dmhc.ca.gov.