Treatment class · subcategory · California
Wearable Cardio Defib denials at external review
When a California health plan denied care in the wearable cardio defib class and the enrollee took it to Independent Medical Review, this is what independent physician reviewers decided.
68.4%
- Overturned
- 26 of 38
- Era
- 2021-2025
- Jurisdiction
- California DMHC IMR
- Published class
- Wearable Cardio Defib
- Median days to decision
- 46
- All years
- 64.2% of 53
Authorities named in this class
computed- American Heart Association—17
- American College of Cardiology—15
- FDA—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
- Cardiac & circulatory68.4%38
The specific conditions inside this class
below n=30, no rate is claimed- Cardiomyopathy—15
- Congestive Heart Failure—5
- Heart Attack—5
- Cardiac/Heart Prob—4
- Arrhythmia/Irregular Heart Rhythm—3
- Coronary Artery Disease—2
- Cardiac Valve Dis—1
- Hypertension—1
By review type
computed- Experimental/Investigational68.6%35
- Medical Necessity—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.