Review type · 2021-2025 · California
Urgent Care
Was this an emergency?
The smallest of the three types by a wide margin, and the one where the prudent-layperson standard governs.
71.8%
of 39 urgent care decisions in 2021-2025 ended with the reviewer not sustaining the denial. All-time, 42.3% of 768.
The trend
computedHover the chart for a year’s counts. Series stops at 2025 — report year 2026 uses a different category vocabulary.
Most-reviewed treatments
computed- Emergency & urgent care—28
- Acute inpatient medical—2
- Diagnostic imaging & screening—2
- Mental Health—2
- OB-GYN procedures—2
- Dental & orthodontic procedures—1
- Diagnostic & physician evaluation—1
- Transportation—1
Most-reviewed conditions
computed- Digestive & GI—8
- Orthopedic & musculoskeletal—8
- Genitourinary & kidney—5
- Cardiac & circulatory—3
- Mental health—3
- Respiratory—3
- CNS & neuromuscular—2
- Cancer—2
- Dental—1
- Post-surgical complications—1
Authorities named in this type
computed- Overturned — the reviewer did not sustain the denial
- Upheld — the reviewer sustained the denial
- American Academy of Child and Adolescent Psychiatry—1
- American College of Obstetricians and Gynecologists—1
- American College of Rheumatology—1
- American Urological Association—1
Free help, first. The California DMHC Help Center files an Independent Medical Review at no cost — 1-888-466-2219, dmhc.ca.gov. It is the same review described on this page. See whether this covers you and what these words mean.
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.