Deny
Harrison, these are the ones used to DENY coverage. I think you will find that they are the same studies that are used to support ADR by other insurance companies. The difference is only in the conclusion at the end that UHC reached or what methodology they use to delegitimize a particular study (not enough participants, not randomized, etc.). As such I think that these are important in understanding how an Aetna treats the same study vs. how UHC treats it. Some companies look at the info and what it says about a treatment while others look for loopholes and flaws to knock a study that doesn't agree with their decision. Essentially I think the business decision is made and then whatever information supports the decision is bolstered and anything that counters it is attacked. A "let's not cloud the issues with facts" approach if you will. Shoot me a private note with your fax number and I will send it over Monday morning.
-----------------------------------------------------------------------------
L5S1 Herniation and Annular tear
Over 10 epidurals,
DDD, 2 discograms (positive),
Countless attempts at conservative therapy.
Surgery date 5-26-09
|