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Idet denials: what the review data shows
Independent reviewers have decided 32 published cases where an insurer denied Idet — and they overturned the insurer 6.3% of the time. A denial for Idet is a starting position, not a final answer.
Published decisions
32
2001–2026
Overturned
6.3%
2 denials reversed
By condition
Published outcomes when Idet was denied for these conditions.
| Condition | Decisions | Overturned |
|---|---|---|
| Back Pain | 13 | 0% |
What the insurer actually argued
Denials fall into different categories, and they don’t succeed equally — so the reason on your letter changes how you should answer it.
| Reason given | Decisions | Overturned |
|---|---|---|
Experimental/Investigational The plan called the treatment unproven. These turn on published evidence, so the appeal is a literature argument. | 29 | 6.9% |
Medical Necessity The plan said the care wasn’t medically necessary. The most common fight, and the most winnable. | 3 | 0% |
Typical time to a decision
21 days
Most land between 20 and 21 days
Handled as urgent
6.2%
Expedited when a delay would cause harm
What the reviewers wrote
Excerpts from the independent reviewers’ published findings — the actual reasoning, quoted, not summarised.
Where the denial was overturned
Physician 1The patient is a 42-year-old female with chronic discogenic low back pain secondary to internal disc derangement at L4-5 and L5-6. The patient underwent provocation discography on 8/17/04 demonstrating diffuse annular disruption at L4-5 and midline radial fissure at L5-6. The patient’s provider has recommended the patient undergo an intradiscal electrothermal therapy (IDET) procedure. The Health Plan indicates the requested procedure is considered experimental and has not been established as more effective than available standard therapies.Review of the submitted clinical information indicates the patient is not a candidate for microdisectomy, fusion or chemonucleoplasty. In addition, the patient has not had significant relief from other treatments utilized such as medications, epidural injections, and facet joint block injections.
Physician 1: The patient is a 22-year-old woman with a history of juvenile lumbar disc disease. She had undergone conservative treatments with no long-term benefit. The patient’s provider has recommended the patient undergo an IDET procedure, which was performed in November 2003. The Health Plan has denied coverage for the requested procedure on the basis it is considered investigational.IDET remains an unproven procedure without clearly defined efficacy. There is no substantial proof of its effectiveness for the treatment of chronic back pain. Multiple studies have demonstrated that it is not beneficial or has limited effect. As such, use of IDET for treatment of patients such as this patient is without clinical merit.
Where the denial was upheld
Worth reading too — these show what an appeal has to overcome.
Physician 1: The patient is a 41-year-old woman with chronic back pain. A request has been made for an intradiscal electrothermal therapy (IDET) procedure. The Health Plan has denied this request on the basis that IDET remains experimental/investigational.There is no information available to warrant and support the use of IDET in the treatment of this patient. No long-term prospective study has shown significant long-term benefits, and the risks of the therapy are still unclear. In this community, when IDET has been used the results have been poor. As such, IDET cannot be recommended until the efficacy of the procedure has been established. Therefore, I have determined that the requested procedure is not likely to be more beneficial for treatment of the patient’s medical condition than any available standard therapy.
Physician 1: The patient is a 42-year-old male who sustained an injury to his back six months ago and has since been on restricted work duty since. He has degenerative disc disease and is requesting coverage for an intradiscal electrothermal therapy (IDET) procedure for his disc herniation.There is no information available to warrant and support the use of IDET. No long-term prospective study has shown significant long-term benefits, and the risks of the therapy are still unclear. At this time, there is no class I data to support the use of IDET for the treatment of lumbar degenerative disc disease. In fact, the recent article by Freeman, et al. in Spine 2005 utilizes class I data to refute the effectiveness of the procedure. IDET cannot be recommended until the efficacy of the procedure has been established.
Figures and quotations on this page come from 42,749 published decisions in the California DMHC Independent Medical Review dataset. These are California outcomes — every state runs an equivalent external review, but the rates here are California’s. Excerpts are quoted verbatim from the public record and describe this treatment generally, not any individual case.
How to use this in your appeal
These are outcomes from California’s external review program — an independent physician panel that binds the insurer. Every state has an equivalent process, and internal appeals succeed even more often. Cite the outcome record for Idetwhen you appeal: reviewers routinely find that denials like yours didn’t hold up.
SOURCE: CALIFORNIA DMHC INDEPENDENT MEDICAL REVIEW OUTCOMES (CHHS OPEN DATA) · DERIVED AGGREGATE STATISTICS ONLY · METHODOLOGY
Not legal or medical advice. Coverage Rights is a self-help tool that helps you prepare your own appeal. For advice about your specific situation, talk to a licensed attorney or your doctor.