I guess I am venting today, but after working on my appeal, I decided to do a Google Search on the Doctor that was the "Medical Director" who denied my pre-certification.
Well he turns out to be an Internal Medicine Specialist who is Board certified in treating Diabetes, and that is what he practices. Now my
medical denial was sent from "The Home Office" in Plano, TX, this Doctor practices in Massachusetts. You would think they would at least get an Orthopedist to "deny" the claim...
What does this guy know about the latest technolgies in Spinal Surgery???

My guess is, he gets hundreds of these claims a month a probably spends a max of about 5 minutes on each.....

I love Insurance Companies.....

John
DDD L5-1

I would sure include that information in your appeal asking for a spine surgeon to review the denial. That's insurance companies for you = get the incorrect specialist to review a claim and then deny it with no justification. Is this even ethical? What does the AMA or State Organization think about this in your State? Let us know what the next response is. Good luck.

I sure will, In my appeal I have asked that it be reviewed by a Specialist that has the proper Certifications to make a decision on my appeal, and if rejected again,(as my state entitles me to) I want to know the name of who rejected my claim, what certifications and diplomas they hold, what Boards are they members of, and what their "practicing" field of expertise is.....

John