Well bad news sigh. I got the packet from the State Ins Commisioners office and they dont have any jurisdiction over self ensured employee health plans which is what we have. I was directed to the Federal office in Atlanta that handles ERISA issues.
They basically told me my only recourse is to file a suit in Federal Court to dispute this. That means hiring an atty, yada yada yada. I asked the gentleman yesterday why the insurance company has no one to answer to when they do not follow their own policies and procedures set out in our beneifts documents. He had no answer for me but was sympathetic.
This really stinks! There should be someone that the insurance companies have to answer to other than the Federal Courts in a situation like this.
I am not out but I am sinking low in the counts today.
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Kim
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
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