Treatment class · subcategory · California
Sedatives/ Hypnotics denials at external review
When a California health plan denied care in the sedatives/ hypnotics class and the enrollee took it to Independent Medical Review, this is what independent physician reviewers decided.
38.2%
- Overturned
- 13 of 34
- Era
- 2021-2025
- Jurisdiction
- California DMHC IMR
- Published class
- Sedatives/ Hypnotics
- Median days to decision
- 38
- All years
- 33.8% of 77
Authorities named in this class
computed- FDA—14
- 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
- CNS & neuromuscular—21
- Mental health—11
- Infectious disease—1
- Orthopedic & musculoskeletal—1
The specific conditions inside this class
below n=30, no rate is claimed- Insomnia—10
- Depression—6
- Narcolepsy—6
- Anxiety—4
- Apnea/Sleep Apnea—2
- Other—2
- AIDS/HIV—1
- Back Pain—1
By review type
computed- Medical Necessity38.7%31
- 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.