Treatment class · subcategory · California
Acute Psych denials at external review
When a California health plan denied care in the acute psych class and the enrollee took it to Independent Medical Review, this is what independent physician reviewers decided.
77.4%
- Overturned
- 24 of 31
- Era
- 2021-2025
- Jurisdiction
- California DMHC IMR
- Published class
- Acute Psych
- Median days to decision
- 41
- All years
- 76.9% of 39
What stands out here
computed from this classmost-cited standard
Reviewers named LOCUS family more than any other standard here — 30 decisions, which came out at 76.7%. Citing a standard and the outcome share a cause; this is not the effect of naming it.
Authorities named in this class
computed- LOCUS family76.7%30
- American Academy of Child and Adolescent Psychiatry—9
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 condition
computed- Overturned — the reviewer did not sustain the denial
- Upheld — the reviewer sustained the denial
- Mental health76.7%30
- Autism spectrum—1
The specific conditions inside this class
below n=30, no rate is claimed- Depression—7
- Bipolar Disorder—6
- Schizophrenia—4
- Substance Use Disorder—3
- ADHD—2
- Eating Disorder—2
- High Risk Suicide—2
- Other—2
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.