Condition class · subcategory · California
Varicose Veins denials at external review
When a California health plan denied care for varicose veins and the enrollee took it to Independent Medical Review, this is what independent physician reviewers decided.
59.0%
- Overturned
- 23 of 39
- Era
- 2021-2025
- Jurisdiction
- California DMHC IMR
- Published class
- Varicose Veins
- Median days to decision
- 33
- All years
- 38.5% of 208
Authorities named in this class
computed- FDA—1
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
- Cardiovascular procedures—26
- Electro, thermal & radiofrequency—8
- Durable medical equipment—1
- Diagnostic imaging & screening—1
- General surgery—1
- OB-GYN procedures—1
- Urology Proc—1
The specific treatments inside this class
below n=30, no rate is claimed- Other—16
- Vein Ablation—11
- Radiofreq Ablat—8
- Compression Garments—1
- Surgery—1
- Ultrasound—1
- Vein Stripping—1
By review type
computed- Experimental/Investigational—20
- Medical Necessity—19
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.