eileen gallagher
05-09-2008, 06:49 AM
I have been thru the entire appeal process and been denied. My insurance is a private policy funded by the company and administered by United Health Care. Therefore, I had to deal both with my employer and UHC. It was an interesting but frustrating experience. It was grossly mishandled from an administrative prospective by both. I have a good argument to file a civil case under ERISA law, just on the federal laws they broke. Their offical ruling was that the surgery was "investigational and not proven by medical peer to peer literature". However, I believe that they misquoted/misrepresented the papers cited. (They quote Drs Zeegers and Zigler as saying that ADR is NOT as good as fusion!!!!!!) I have asked for copies of all the papers cited. In the meantime, I am looking for a lawyer. Anyone have one that has filed a civil suit under ERISA law?