[Harrison]

"...The main point I want to make is that you or a family member need to be the the one in control of the entire appeal process. You must be polite, proactive and assertive if you want the best care possible! Don't just assume that your surgeon or his staff will do it for you. If your surgeon, doctor, lawyer is any good then they will be too busy to do it all for you..."

Sooner, thanks for your post – this excerpt hit all the nails on the head! For what it's worth, Medtronic’s appeals department has their own employees (rather than outsourcing or partnering) and will assist at all stages of a one-level (single level ADR) insurance appeal. Their success rate is reportedly 80%, which seems remarkably high – especially since it saves the time, cost and frustration of having to hire an attorney. I believe they may assist with two level (off label or compassionate use appeals), but not with the same level of commitment as a one level (for a long list of reasons).

BTW: Anyone that explains ERISA that succinctly is a gifted teacher, government bureaucrat or an extraterrestrial!

Thanks for sharing.