Condition class · subcategory · California
Thyroid Problems denials at external review
When a California health plan denied care for thyroid problems and the enrollee took it to Independent Medical Review, this is what independent physician reviewers decided.
65.9%
- Overturned
- 29 of 44
- Era
- 2021-2025
- Jurisdiction
- California DMHC IMR
- Published class
- Thyroid Problems
- Median days to decision
- 38
- All years
- 63.7% of 182
Authorities named in this class
computed- FDA—8
A rate here is the outcome of decisions that named the authority, not the effect of naming it. Reviewers cite the standard they applied; the citation and the outcome share a cause.
By treatment
computed- Overturned — the reviewer did not sustain the denial
- Upheld — the reviewer sustained the denial
- Pharmacy—20
- Electro, thermal & radiofrequency—12
- Diagnostic imaging & screening—4
- General surgery—3
- Durable medical equipment—2
- Skilled nursing & inpatient rehab—2
- Reconstructive & plastic procedures—1
The specific treatments inside this class
below n=30, no rate is claimed- Radiofreq Ablat—12
- Biologics—9
- Hormones—5
- Other—5
- Weight Control—5
- Breast Pump—1
- Genetic/Genomic Test—1
- Inpt Admission—1
By review type
computed- Medical Necessity—29
- Experimental/Investigational—15
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.