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-   -   Independent Medical Review (https://www.adrsupport.org/forums/showthread.php?t=5429)

go*big*red 03-10-2006 01:18 PM

Hi, all.

Okay, the next and final step is an Independent Medical Review. There has not been a case where UHC or Pacificare for that matter has approved an artificial disc replacement to date. But, why not me????? Why can't I be the first????? Someone has to be, right?

How long does it take for an Independent Review? I realize that it varies, but can anyone give me an idea? I'm dieing here.

03-10-2006 02:25 PM

blue crap told like 2 weeks
chuck

Harrison 03-10-2006 05:23 PM

I believe Chuck is referring to Blue Cross Blue Shield, also known as Blue Corpse Blue Sled.

http://adrsupport.org/groupee_common...n_rolleyes.gif

go*big*red 03-10-2006 05:49 PM

Yeah, that's what I figured, Harrison. http://adrsupport.org/groupee_common.../icon_razz.gif

So, Chuck, in reading your signature line, you are still waiting for SOMETHING??? http://adrsupport.org/groupee_common...s/icon_eek.gif

Kim 03-10-2006 11:44 PM

I read somewhere by law they have 30 days to do the review in but dont hold your breath it will be in your hands in 30 days mine would do the review and date it the day before the 30 days was up or on the 30 day mark then took about 10 days to get it out to me.
I had Great West then but have UHC now. Hope this helps

03-11-2006 08:34 AM

go*big*red
i leaving tomorrow sunday to guilford ct to see dr james yue. to see if i can get into the fda clinial trials comparing prodisc to activ-l adr. if im not a candidate ill be asking for a referal to pro-spine
i have my lastest films on cd both ct scan and mri no concast.cd is cool all the nurses told me they don't do that but later talked to someone else and said it was no problem and it was free. also includes all the reports. just put cd in a pc and has the 3d viewer all on the disc.i have been waiting and fighting with insurance company for well over 2 yrs enough im getting fixed this yr 2006. so hopefully im still good to go i was offered the prodisc study by dr balderston at pa hosp a yr ago so i hope i still am. i really rather not have to borrow the money in case i end up in that 10% that doesnt do well.
best wishes
chuck

03-11-2006 08:42 AM

go*big*red
also watch the appeal process but your reply time for appeals gets shorter after each appeal the second appeal with blue crap i only 2 weeks to get the last one started. they really r pricks {insurance companys} and what really kills me is the ceo of blue crap here made 27 million last yr. and this yr there asking for a 30% increase in premiums. and they dont want to pay for any thing. i had letters written by professions. and in my mind all apeals were denied before they hit anyones desk. i also sent about 50 pounds of info comparring adr to fusion to not advil.hopefully this isnt the case for you http://adrsupport.org/groupee_common...icon_smile.gif
wishing you the best of luck with our appeals one thing in your favor is more time has passed.
chuck

Paul 03-13-2006 05:41 PM

Good luck with that. I had no luck with UHC. The whole process is a scam. The get to pick the doctors etc. It is a total crock. They pay these retired fossils to do the reviews so you know where they are going to side on. My first appeal doc was a retired arthritis doctor. I have heard also that they use a diabetes specialist. From the time I have spent on this forum I have noticed UHC being the worse. That being said someone has to be the first so I hope you are it. Good luck.

APS 03-13-2006 11:39 PM

Hi all,
I haven't posted in awhile. I am working on my first appeal letter to UHC right now. My denial letter was signed by a medical director whose specialty was geriatric/elder care. That's helpful...not.
And yes, someone has to be first, so no giving up!
Andrea

Kim 03-13-2006 11:48 PM

I agree with the 2 above my first appeal was reviewed by an OB/GYN, the second time supposedly by an orthoapedic surgeon. His suggestions were so ludicrous that I questioned it. I got through to find out who he was and ROFL he was a local doc here so I called his office and asked them about him. I found out he was a sports med dr and worked on elbows, shoulders and knees, had not done any spine surgery for 12 years since he was in the military. U can bet I brought this up in my final appeal. Same thing happened again sigh. Its so great they call it an independant medical review but they get to choose the company and of course the ins pays for the consultation so which side do you think the doc is going to decide on and how long would he be employed in such endeavors if he disagrees with the ins company and they have to approve procedures that they dont want to?
Oh and get this, the ins company rep told me that they dont even specify who the doc is when they send a case to the medical review company they leave it up to that company to find someone who is qualified.
Oh the wonderful things u can find out when you delve into the workings of the lovely insurance folks.
I wish you much luck and much more luck than I had during the process.
I had Great West and now I have UHC and from what I have seen so far yeah you can do worse Great West is by far the worst ins I have ever dealt with in all my years. That includes 25 years background in the medical field and even did some insurance billing for a few years a while back.


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