Spotty,
I addressed the legal issue in another post here I think. Much has changed in CA. as you know since Jan.05 and the tightening up on rules and regs. I hear that sending everything thru Utilization Review each time a request for any treatment is needed would pay for many patient's surgeries, as it's very costly for miniscule requests..
What I need now is cold hard data to go up against the powers that be in the company. I had many articles quite some time ago but they are older and I need to follow up with more recent information in terms of studies and what docs are doing where (multilevel surgeries in US).
This is just to arm myself against the new head of the Claims dept to bring a good arguement as why I should even be trying to pursue ADR and get any other consultations for it, let alone getting it. If I can at least present a good arguement with actual factual data I may just have some slip of a chance still.. at least there'd be an arguement that is presented that might give reason to override the "no" that UR will automatically give just because the devices are either not FDA approved, haven't been around long enough to study in this country, haven't had that much of a difference in success rate than fusion overall, or because the one FDA approved implant states on website only approved for one level implantation and with DDD at one level.
Time for me to get busy with researching data again..
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