View Single Post
Old 03-13-2006, 11:48 PM
Kim Kim is offline
Senior Member
Join Date: Apr 2005
Posts: 267

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.
Herniated disc L5/S1 2000 Discectomy 10/2003 Rhizotomy 8/2004 and 3/2005Discogram 11/04 grade 7 tear L5/S1
L4/L5 Grade 5 tear with herniation and stenosis
Evaluated by Dr Blumenthal at TBI
2/2005 ADR 2 level recommended
2 level lumbar fusion
Reply With Quote