Hyperbaric O2 Chamb for CNS/ Neuromusc Dis: 16.7% of denials overturned
In 6 California IMR decisions from 2002 to 2025, reviewers overturned 1 (16.7%). In the last five years: 0.0% of 1. 2 were medical-necessity disputes, 4 experimental/investigational.
By year (last five)
| Year | Decisions | Overturned |
|---|---|---|
| 2025 | 1 | 0.0% |
What the findings mention
| What the findings mention | Decisions | Overturned | All decisions here |
|---|---|---|---|
| Published evidence citedThe findings refer to peer-reviewed or published evidence. | 3 | 33.3% | 16.7% |
Keyword matches on the reviewer’s findings, not causes. A tag that appears mostly in overturned decisions is worth documenting in an appeal; it is not a guarantee.
From recent overturned decisions
“The parent of a 13-year-old female enrollee has requested systemic hyperbaric oxygen therapy for treatment of the enrollee’s brainstem glioma. Findings: Three physician reviewers found that childhood brainstem gliomas are extremely rare (Pfister and Witt). Radiation therapy is the mainstay of treatment, but it is not without its complications, including necrosis and edema (Govindan). This patient received several radiation doses …”
And one the reviewer upheld
“Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for hyperbaric oxygen therapy. As evidenced by the medical literature, hyperbaric oxygen therapy is a well-established treatment for certain medical conditions, but the management of both chronic venous stasis ulcers and cerebral palsy are not included in the indications list recognized by the Undersea and Hyperbaric Medical Society …”
- California only: these are decisions by independent reviewers under California's IMR program (plans regulated by the Department of Managed Health Care). Other states and self-funded employer plans use different reviewers and rules.
- Selection: only denials that a member took all the way to IMR appear. Most denials are never appealed, and the ones that reach an external reviewer are not a random sample.
- Overturned means the reviewer disagreed with the plan; it does not mean the treatment worked or that a similar request will be approved.
- Argument tags are keyword matches on the reviewer's findings. They describe what the findings mention, not why the case was decided.
- Categories are DMHC's own labels (treatment sub-category and diagnosis category); 'Other' is a catch-all and is excluded from rankings.
Source: California Department of Managed Health Care, Independent Medical Review (IMR) Determinations, Trend (CHHS Open Data). Public California government data; Apellica's aggregates and tags are CC BY 4.0.
Questions
How often were Hyperbaric O2 Chamb denials for CNS/ Neuromusc Dis overturned?
In 6 California IMR decisions from 2002 to 2025, reviewers overturned 1 (16.7%). In the last five years: 0.0% of 1. 2 were medical-necessity disputes, 4 experimental/investigational.
What should an appeal document, based on these findings?
Whatever the plan's criteria ask for, shown in the record: the treatments already tried and their results, contraindications to the plan's preferred option, the guideline or evidence that supports the request, and the treating clinician's reasoning written to the criteria. The tag table shows which of these the reviewers mentioned most in overturned cases.
Does a California IMR result apply to my plan?
Only California plans regulated by the Department of Managed Health Care go to IMR. Other states and self-funded employer plans use different reviewers, but they weigh the same things.
Independent reviewers reverse plans when the record answers the criteria. Upload the denial letter; a senior reviewer reads it within 24 hours and tells you in writing whether it can be appealed and how. $0 upfront, 10% of what is recovered, nothing if we do not recover. Not a law firm.