Treatment class · subcategory · California
Psychotherapy denials at external review
When a California health plan denied care in the psychotherapy class and the enrollee took it to Independent Medical Review, this is what independent physician reviewers decided.
80.0%
- Overturned
- 28 of 35
- Era
- 2021-2025
- Jurisdiction
- California DMHC IMR
- Published class
- Psychotherapy
- Median days to decision
- 40
- All years
- 52.1% of 167
Authorities named in this class
computed- LOCUS family—24
- American Academy of Child and Adolescent Psychiatry—5
- American Psychiatric Association—4
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 health79.4%34
- Autism spectrum—1
The specific conditions inside this class
below n=30, no rate is claimed- Depression—9
- Anxiety—8
- PTSD—6
- Borderline Personality Dis—3
- Eating Disorder—3
- Autistic Disorder—1
- Bipolar Disorder—1
- Obsess/Compulsive—1
By review type
computed- Medical Necessity82.4%34
- Urgent Care—1
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.