California · 2021-2025 · 92 classes
Treatment classes
What independent physician reviewers decided, by the kind of care the plan denied. 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
22 broad classes22 classes, from skilled nursing & inpatient rehab at 23.9% to neurosurgery at 86.0%. Median class: 53.6%.
- Skilled nursing & inpatient rehab24%
- Alternative treatment30%
- Orthopedic procedures31%
- Outpatient rehabilitation39%
- Home Health Care42%
- Special procedures42%
- Reconstructive & plastic procedures46%
- Diagnostic imaging & screening48%
- OB-GYN procedures50%
- Autism-related treatment51%
- Cancer Care53%
- Diagnostic & physician evaluation54%
- General surgery55%
- Durable medical equipment56%
- Electro, thermal & radiofrequency57%
- Acute inpatient medical62%
- Cardiovascular procedures62%
- Pharmacy75%
- Ear, nose & throat procedures76%
- Pain Management80%
- Mental Health80%
- Neurosurgery86%
Find your class
by number of decisions- Overturned — the reviewer did not sustain the denial
- Upheld — the reviewer sustained the denial
- Pharmacy74.6%4,121
- Mental Health79.8%1,558
- Diagnostic imaging & screening47.8%1,248
- Pain Management79.5%937
- Durable medical equipment56.0%679
- Cancer Care52.6%485
- Orthopedic procedures30.5%377
- Reconstructive & plastic procedures45.9%283
- Electro, thermal & radiofrequency56.7%210
- Ear, nose & throat procedures76.2%189
- Autism-related treatment51.2%172
- Outpatient rehabilitation39.2%158
- General surgery54.8%157
- Cardiovascular procedures62.3%154
- Skilled nursing & inpatient rehab23.9%134
- Acute inpatient medical62.1%124
- Special procedures41.8%122
- Diagnostic & physician evaluation53.6%112
- OB-GYN procedures50.0%60
- Neurosurgery86.0%50
- Alternative treatment29.8%47
- Home Health Care41.5%41
Subcategories
70 of 70 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.
- Weight Control87.0%1,434
- RTC79.4%1,153
- Viscosupp Injection97.7%529
- Biologics81.4%392
- Genetic/Genomic Test53.0%313
- MRI52.2%291
- Hormones47.8%272
- Skin Treatment80.9%246
- Diabetic Medication77.1%227
- Lab Work25.1%167
- Digestion/GI Rx79.4%165
- Proton Beam51.3%156
- Pain Medication37.3%153
- IVIG Therapy62.2%148
- Cancer Rx45.8%144
- Nerve Block70.6%143
- Migraine Rx82.8%128
- Radiofreq Ablat59.0%122
- CT Scan33.9%115
- Partial Hospital85.5%110
- Intensive Outpt Prog88.2%102
- Sinus Surgery84.2%101
- Glucose Monitor75.5%98
- Admission69.3%88
- Botox Injection72.4%87
- PET Scan66.3%86
- Appld Behav Analysis44.0%84
- Neuromuscular RX90.0%80
- Inpt Admission28.9%76
- Physical Therapy28.0%75
- Radiation Therapy60.3%73
- Arthritis Rx72.2%72
- Cardiac Rx36.1%72
- SCP Consult Refer66.2%68
- Speech Therapy63.2%68
- Anti-inflammatories66.2%65
- Fusion34.9%63
- Artificial Disc Repl22.2%54
- Epidural Injection61.1%54
- Surgery69.8%53
- TMS80.4%51
- Arthroscopy24.5%49
- Ultrasound56.2%48
- ADD/ADHD Rx63.8%47
- Occupational Therapy43.5%46
- Special Bed65.2%46
- Orthotics80.0%45
- Individ Counsel84.1%44
- GERD Procedure40.5%42
- Bariatric Surgery63.4%41
- Glucagon-Like Peptide-1 (GLP)73.2%41
- Anti-Depressants50.0%40
- Inpt Discharge12.5%40
- Steroid Injection75.0%40
- Panniculectomy26.3%38
- Wearable Cardio Defib68.4%38
- Antibiotics67.6%37
- Liposuction35.1%37
- Osteoporosis Rx69.4%36
- Asthma Rx71.4%35
- Psychotherapy80.0%35
- Sedatives/ Hypnotics38.2%34
- General Anesthesia45.5%33
- Hyperbaric O2 Chamb28.1%32
- Knee Replacement12.5%32
- Acute Psych77.4%31
- Breast reduction67.7%31
- Acupuncture26.7%30
- Electric Wheelchair20.0%30
- Prosthesis53.3%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.