Treatment class · subcategory · California
Panniculectomy denials at external review
When a California health plan denied care in the panniculectomy class and the enrollee took it to Independent Medical Review, this is what independent physician reviewers decided.
26.3%
- Overturned
- 10 of 38
- Era
- 2021-2025
- Jurisdiction
- California DMHC IMR
- Published class
- Panniculectomy
- Median days to decision
- 56
- All years
- 33.1% of 178
What stands out here
computed from this classamong the lowest
At 26.3%, this is the 7th-lowest overturn rate of the 70 treatment classes carrying one — one of the few where reviewers more often agreed with the plan than not.
Authorities named in this class
computed- American Society of Plastic Surgeons—13
- WPATH—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
- Skin24.2%33
- Endocrine & metabolic—2
- Mental health—1
- Orthopedic & musculoskeletal—1
- Post-surgical complications—1
The specific conditions inside this class
below n=30, no rate is claimed- Excess Skin—29
- Other—4
- Lipedema (Lipoedema)—2
- Back Pain—1
- Gender Dysphoria—1
- Rash—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.