Quote:
Originally Posted by Running11
Dear Gene,
Thanks for responding. I can't appeal anymore this is the end of the road.It was the external review that went out to a third party; MCMC.
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Running,
Nothing is final until a judge in a court of law makes a decision. Just because the insurance appeals process is over doesn't mean that this process is. In fact I see it as just the beginning. I suggest you get an attorney involved (probably one who specializes in personal injury or malpractice would be best). If the attorney writes a certified letter, stressing all the points and opinions of 12 doctors of why you should have surgery, it's likely to reach someone at a different level of BCBS who most likely has a brain. Believe me, the insurance company does not want to get involved in litigation. They would have to hire their own attorney or take time away from one of their in-house counsel members. The burden of proof now shifts to them. They are the ones who must
prove that you won't benefit from any surgery. Good luck to them with everything you have to show otherwise.
Yes, you are going to probably have to pay a few thousand dollars to an attorney. However, if it gets your surgery ultimately covered by BCBS, it's money well spent. It's also far less than you would spend traveling to Europe to have it done there. IMO, I don't think this is going to get further than a certified letter from an attorney. Once they see they you have one involved, they are likely to back off. They know that if anything ends up wrong with you because they refused to pay for the procedure, they are in for a very big lawsuit. Nobody wants that.
Time to contact an attorney. Please keep me posted.
Gene