Treatment class · subcategory · California
Asthma Rx denials at external review
When a California health plan denied care in the asthma rx class and the enrollee took it to Independent Medical Review, this is what independent physician reviewers decided.
71.4%
- Overturned
- 25 of 35
- Era
- 2021-2025
- Jurisdiction
- California DMHC IMR
- Published class
- Asthma Rx
- Median days to decision
- 22
- All years
- 70.0% of 50
Authorities named in this class
computed- FDA—17
- MCG / Milliman—4
- American Thoracic Society—1
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
- Respiratory69.7%33
- Autism spectrum—1
- Ear, nose & throat—1
The specific conditions inside this class
below n=30, no rate is claimed- Asthma73.3%30
- Breathing Problem—2
- Autistic Disorder—1
- Other—1
- Rhinitis—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.