Treatment class · subcategory · California
Osteoporosis Rx denials at external review
When a California health plan denied care in the osteoporosis rx class and the enrollee took it to Independent Medical Review, this is what independent physician reviewers decided.
69.4%
- Overturned
- 25 of 36
- Era
- 2021-2025
- Jurisdiction
- California DMHC IMR
- Published class
- Osteoporosis Rx
- Median days to decision
- 32
- All years
- 67.3% of 55
Authorities named in this class
computed- FDA—12
- MCG / Milliman—3
- American College of Physicians—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
- Orthopedic & musculoskeletal69.4%36
The specific conditions inside this class
below n=30, no rate is claimed- Osteoporosis68.8%32
- Osteoarthritis—2
- Back Pain—1
- Vertebral Disc Prob—1
By review type
computed- Medical Necessity66.7%33
- Experimental/Investigational—3
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.