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-   -   Optima - Denied (https://www.adrsupport.org/forums/showthread.php?t=13311)

Romakis 12-14-2015 08:08 AM

Optima - Denied
 
Just got the letter back from my insurance company: Denied.

Denial codes: "D84F - Not medically necessary per Medical Director - Member responsible."

"The requested service is considered investigational and not medically necessary per Optima Policy Surgical 78".

What a surprise... :)

Stonewall_Boris 12-14-2015 04:01 PM

Are you going to appeal?

Harrison 12-15-2015 06:08 PM

1 Attachment(s)
Romakis,

This may or may not help...see attached. Make the calls / letters anyway. It's a small effort that have a big ROI.

Romakis 12-16-2015 09:38 AM

Appeal
 
Yes, I am going to try to appeal. Thanks Harrison.

Romakis 12-16-2015 04:21 PM

Help
 
If anyone has any documentation to help me file an appeal, I would highly appreciate it. Please let me know and I will give you my e-mail address. Thank you all in advance!

Romakis 12-17-2015 09:05 AM

Quote:

Originally Posted by Harrison (Post 112504)
Romakis,

This may or may not help...see attached. Make the calls / letters anyway. It's a small effort that have a big ROI.

I called my insurance yesterday, and after 30 minutes of run around they gave me a name of the doctor who accessed my claim and made denial recommendation. I googled this doctor's name and this is what I found:

"Dr. Peggy Ebinger, MD is a psychiatrist in Virginia Beach, Virginia."

:clap::clap::clap:

Romakis 02-17-2016 01:32 PM

My appeal package
 
1 Attachment(s)
Sending the documentation today. Thank you all who helped me put it together (Jerry, Andi, thank you so much!!!).

Had a hard time finding an envelope to fit all the paperwork... :laugh::laugh::laugh:

JinSong 02-21-2016 07:06 AM

Wow, so the person making the decision was a freaking psychiatrist?! I'm entering into my own ADR denial hell, so this is good information to have.

Romakis 05-05-2016 08:08 AM

Appeal is also denied
 
1 Attachment(s)
As I expected, the appeal was denied as well by Optima Health. They stated that it was not "medically necessary", and that discectomy should have been used instead :jacks:.

I guess I should have cut the rest of my discs out, and leave everything else as is :jump:.

Man, my appeal was so thick and looked so good :)...

Disc replacement 2015 05-05-2016 11:26 AM

That really sucks!!! Sorry to hear...


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