To my surprise (well, maybe not) MAMSI denied my coverage yesterday for a one-level ADR at L5-S1, stating that it's "unproven/experimental." They apparently have chosen to ignore the OPM regulation that clearly states that for Federal Employee Health Benefit plans, any FDA-approved drug, device or product cannot be deemed "experimental" or "investigational".
The appeal is already written and will be in the mail tomorrow. The appeal basically says that the FDA has approved Charite ADR, they're obligated to cover all FDA-approved procedures, so they either approve it or incur the wrath of the Federal Government for violating OPM regulations.
I really sympathize with those of you that are at the mercy of the insurance providers and that don't have any recourse for independent appeal...
-stan
__________________
Stan
L5-S1 DDD and herniation
|