Treatment class · subcategory · California
Acupuncture denials at external review
When a California health plan denied care in the acupuncture class and the enrollee took it to Independent Medical Review, this is what independent physician reviewers decided.
26.7%
- Overturned
- 8 of 30
- Era
- 2021-2025
- Jurisdiction
- California DMHC IMR
- Published class
- Acupuncture
- Median days to decision
- 40
- All years
- 39.2% of 204
8 overturned22 upheld
By condition
computed- Overturned — the reviewer did not sustain the denial
- Upheld — the reviewer sustained the denial
- Orthopedic & musculoskeletal—15
- CNS & neuromuscular—3
- Cardiac & circulatory—2
- Foot—2
- Trauma & injuries—2
- Digestive & GI—1
- Ear, nose & throat—1
- Endocrine & metabolic—1
The specific conditions inside this class
below n=30, no rate is claimed- Back Pain—5
- Shoulder Problem/Pain—4
- Auto Accident—2
- Osteoarthritis—2
- Other—2
- Stroke/ CVA—2
- Blindness—1
- Diabetes—1
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.