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Everything here is free to read, and nothing here is a claim about your case. Built from California’s published records and modified by us — not official government data. How these numbers were made.

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Treatment class · subcategory · California

Intensive Outpt Prog denials at external review

When a California health plan denied care in the intensive outpt prog class and the enrollee took it to Independent Medical Review, this is what independent physician reviewers decided.

88.2%

Overturned
90 of 102
Era
2021-2025
Jurisdiction
California DMHC IMR
Published class
Intensive Outpt Prog
Median days to decision
38
All years
71.7% of 307
90 overturned12 upheld

What stands out here

computed from this class

  • among the highest

    At 88.2%, this is the 3rd highest overturn rate of the 70 treatment classes with enough decisions to publish one. Reviewers sustained the plan in the remaining 11.8% of disputes.

  • rising

    It has risen over the published record: 52.6% in 2017 against 90.6% in 2021. What drove that is not in this data — the file holds outcomes, not who chose to appeal or how plans changed their own review.

  • most-cited standard

    Reviewers named LOCUS family more than any other standard here — 84 decisions, which came out at 90.5%. Citing a standard and the outcome share a cause; this is not the effect of naming it.

The trend, with its era

computed
0%25%50%75%100%90.6%201720202021Share of decisions overturning the health plan · years below n=30 omitted

Hover the chart for a year’s counts. Series stops at 2025 — report year 2026 uses a different category vocabulary.

What reviewers relied on

3 validated codes

California requires each published decision to carry “a detailed case summary that includes the specific standards, criteria, and medical and scientific evidence, if any, that led to the case decision” (Health & Safety Code § 1374.33(h)(1)(K)). These are the elements our extraction found in this class, split by how the decision came out.

What the reviewer relied onIn overturnsIn upholds
the FDA label or approval status0%n=90—
a standardised level-of-care instrument96%n=90—
a California statutory definition4%n=90—

Read as description, not instruction. These are patterns in what reviewers wrote, not steps to follow, and no combination of them predicts an outcome. Only codes that cleared the validation gate appear — thirteen did not.

Authorities named in this class

computed
  • LOCUS family90.5%84
  • American Academy of Child and Adolescent Psychiatry90.0%50
  • American Society of Addiction Medicine—6

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 health90.3%93
  • Autism spectrum—8
  • CNS & neuromuscular—1

Browse all condition classes · Pick your own pair

The specific conditions inside this class

below n=30, no rate is claimed
  • Depression90.2%41
  • Anxiety—16
  • Autistic Disorder—8
  • ADHD—6
  • PTSD—5
  • Eating Disorder—4
  • Obsess/Compulsive—4
  • Other—4

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.