Rant/Vent about Insurance

[stacyrg2 350]

No appeal policy? Wow. What state are you in?

I'm in California, but it's not a State rule. It's an internal procedure with my insurance company. For this particular procedure, they are a one look, no right to appeal. That's why my surgeon's request for peer to peer has been denied twice. He keeps trying, going up the chain of command with each request. That's also why I have the request for Independent Medical Review pending with the Department of Insurance. The one look, no appeal is clearly stated in the disclaimer letter and has been confirmed by the stretta people who have faced that position from this insurer before.

[2goldengirl 2,076]

So if you have a DOI product, I'm guessing you have P P O coverage. As I understand it, no matter the product, in CA you definitely have the right to IMR.

[stacyrg2 350]

Yes, I have PPO. You have the right to request an IMR. The DOI has the right to evaluate whether the claim qualifies for an IMR. If so, they have 30 days from the date they receive a response from the insurance co to rule

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