Last week, I posted that my surgery for this Thursday was cancelled because my insurance company denied the claim. I started this new topic because anyone who already read it, might not visit it again.

After an exhasting week fighting Blue Cross of CA and feeling that I had been treated badly, I asked if they had a governing body. In CA, it's the Dept. of Managed Health Care and they are now doing an independent health review on my behalf. Once all the documenation required is received, they can take up to 45 days.

I don't know where this will lead, but I would think that every state has their own governing body that might take up the fight with you. At the very least, it can't hurt.

Please feel free to email me directly if you have any questions steugirl@pacbell.net

Good luck to all, Dale

Dale,

Good luck with the review, I hope the results are in your favor.

The experience I've had with Blue Shield and the independent reviews has been positive, the 2 I've had, have come back in less than a month.

Gem

The department of managed health care in california is a regulatory agency for HMO's and they may (under certain circumstances) offer an Independent Medical Review of a case. However, careful review of their cases (you are free to research their decisions using their online databse) shows that they have NEVER approved/overturned a decision by an insurance company to deny coverage of an artificial disc replacement. Having gone down that route w/my fiancee I almost suspect we were enticed by the insurance company to go down that route since they were well aware of the DMHC's position.
Thanks
Here's the link to the website:
http://www.hmohelp.ca.gov/