Treatment class · subcategory · California
Anti-Depressants denials at external review
When a California health plan denied care in the anti-depressants class and the enrollee took it to Independent Medical Review, this is what independent physician reviewers decided.
50.0%
- Overturned
- 20 of 40
- Era
- 2021-2025
- Jurisdiction
- California DMHC IMR
- Published class
- Anti-Depressants
- Median days to decision
- 41
- All years
- 52.0% of 102
Authorities named in this class
computed- FDA—15
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 health50.0%40
The specific conditions inside this class
below n=30, no rate is claimed- Depression55.9%34
- ADHD—1
- Anxiety—1
- Bipolar Disorder—1
- Other—1
- Panic Disorder—1
- Schizophrenia—1
By review type
computed- Medical Necessity57.6%33
- Experimental/Investigational—7
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.