Hyperbaric O2 Chamb for Skin Disorders: 42.9% of denials overturned
In 14 California IMR decisions from 2006 to 2025, reviewers overturned 6 (42.9%). In the last five years: 30.0% of 10. 10 were medical-necessity disputes, 4 experimental/investigational.
By year (last five)
| Year | Decisions | Overturned |
|---|---|---|
| 2022 | 4 | 0.0% |
| 2023 | 3 | 66.7% |
| 2024 | 2 | 0.0% |
| 2025 | 1 | 100.0% |
What the findings mention
| What the findings mention | Decisions | Overturned | All decisions here |
|---|---|---|---|
| Published evidence citedThe findings refer to peer-reviewed or published evidence. | 9 | 33.3% | 42.9% |
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
“Nature of Statutory Criteria/Case Summary: The patient requested reimbursement for hyperbaric treatments provided on a daily basis, including weekends. In this case, the patient underwent bilateral modified mastectomies with advancement flaps and free nipple grafting. The provider postoperatively diagnosed threatened and compromised surgical flaps with ischemic changes threatening the newly grafted tissue. Thus, hyperbaric treatments provided on a daily basis, …”
“The physician reviewer found that Nature of Statutory Criteria/Case Summary: The patient has requested reimbursement for hyperbaric oxygen therapy. In this case, the patient underwent significant transgender surgery. Photographs submitted on behalf of the patient showed evidence of a hypoxic surgical site indicative of a threatened flap/graft. Researchers report, “The expedient initiation of hyperbaric oxygen therapy as soon as flap …”
“Nature of Statutory Criteria/Case Summary: An enrollee has requested authorization and coverage for additional hyperbaric oxygen therapy (HBOT) treatment. Although there are limited data from prospective randomized controlled clinical trials demonstrating improved health outcomes with HBOT in this patient’s clinical setting, there are data suggesting that HBOT may be beneficial. One study evaluated patients with nonhealing chronic wounds who were …”
And one the reviewer upheld
“The physician reviewer found that the patient status post bilateral breast reduction who requested authorization and coverage for hyperbaric oxygen treatment. Hyperbaric oxygen therapy can play a critical role in flap salvage when prompt and/or immediate institution of hyperbaric therapy is initiated, typically within 48 hours following signs of ischemia. Per the medical records in this case, hyperbaric oxygen therapy …”
- 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 Skin Disorders overturned?
In 14 California IMR decisions from 2006 to 2025, reviewers overturned 6 (42.9%). In the last five years: 30.0% of 10. 10 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.