It's been quite the roller-coaster ride. We submitted originally, over 30 pages of documentation. It got sent to International, who said it would be paid. YIPPEE!
Then it turns out, that no, they won't pay.
They tell us they need us to prove it was an emergency surgery, and we submit a letter from Dr. Clavel saying it was done on an emergency basis, and that had the surgery not been done, I would be in a wheelchair right now.
So then they deny us (again) based on us not showing medical necessity. (WTF?!) We sent them, literally, EVERY document they asked for, and more. So I'm failing to see how we did not show medical necessity.
At this point we have used up our two appeals. They are suggesting we do an IMR (which I do NOT want to do for reasons I can go into later, but not right now). We, of course, can file a grievance.
I'm wondering if anyone has any suggestions as to what to do at this point.
HELP?