THE CALIFORNIA SCORECARD
Since November 1, 2021, 38 state-licensed California treatment facilities have been keeping score of the denials, and approvals, made by doctors sent by insurance companies, or working for insurance companies, to evaluate the request of an addiction doctor to extend days of treatment, or change the level of care. On January 1, 2021 California mandated using ASAM criteria for addiction treatment, but the denial rates for many if not all doctors who do peer-to-peer reviews, or write the official denials, continue to be 90-100%.
There are currently 20 doctors listed in the scorecards (their names are redacted for public consumption) deny or authorize. As stated above, many doctors refuse to disclose their full names and medical credentials. We are in the process of acquiring information about an additional 1-2 dozen doctors and will update the list as that information becomes available.
| SCOREBOARD OF PEER-TO-PEER DENIAL RATES COLLECTED BY 51 CA FACILITIES SINCE 11/1/2021 | |||||
|
#
|
TYPE OF DOCTOR
|
Licensed in which states?
|
CARRIER
|
ASAM certified?
|
Denial Rate
|
| Dr #1 | Family Doctor | CA | PREST | no ASAM, no ABPM) | 100% |
| Dr #2 | Psychiatrist | CA | ANTHEM | no ASAM, no ABPM) | 100% |
| Dr #3 | Psychiatrist | CA | BEACON & AETNA | no ASAM, no ABPM) | 100% |
| Dr #4 | Psychiatry | CT, FL, NY, NH, VT | CIGNA | no ASAM, no ABPM) | 100% |
| Dr #5 | Child & Adolescent Psychiatry, Forensic Psychiatry | CA | ANTHEM | no ASAM, no ABPM) | 100% |
| Dr #6 | Psychiatrist, Geriatric Psychiatry | CA | CIGNA | no ASAM, no ABPM) | 100% |
| Dr #7 | Child & Adolescent Psychiatrist | IL and NM | PREST | no ASAM, no ABPM) | 100% |
| Dr #8 | Psychiatrist | CA | ANTHEM | no ASAM, no ABPM) | 100% |
| Dr #9 | Psychiatrist, Psychomatic Med. |
CA, AZ, FL, AR, NH, NC, PA, TX, VE
|
EVERNORTH | no ASAM, no ABPM) | 100% |
| Dr #10 | Child & Adolescent Psychiatrist | CA | ANTHEM | no ASAM, no ABPM) | 100% |
| Dr #11 | Child & Adolescent Psychiatry Specialist | CA | PREST | no ASAM, no ABPM) | 95% |
| Dr #12 | Psychiatrist | CA | MSN/HN | no ASAM, no ABPM) | 92% |
| Dr #13 | Psychiatry | CA | PREST | no ASAM, no ABPM) | 90% |
| Dr #14 | Psychiatry, Geriatic | CA | ANTHEM | no ASAM, no ABPM) | 85% |
| Dr #15 | Psychiatry | WI | PREST | no ASAM, no ABPM) | 83% |
| Dr #16 | Child & Adolescent Psychiatrist | AZ, FL, KY, MS, NC | PREST | no ASAM, no ABPM) | 75% |
| Dr #17 | Psychiatry | CA | PREST | no ASAM, no ABPM) | 75% |
| Dr #18 | Child Psychiatrist | will not reveal | Beacon | knows "nothing about addiction", no ASAM, no ABPM) | 60% |
| Dr #19 | Child / Adolescent Psychiatrist | CA | ANTHEM | no ASAM, no ABPM) | 60% |
| Dr #20 | Psychiatrist | OK | Aetna | no ASAM, no ABPM) | 50% |
.
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