Final appeal - External review

[sahuaro]

Several thoughts in reading about difficulties with ADR coverage:
(1) You are absolutely correct in being suspicious of the "external review" doctor--sort of like the "independent medical examiner". NBC's dateline has done several exposes of State Farm insurance and their "external reviews"

(2)If Medicare will indeed reimburse for ADR, this is a good sign, since Medicare usually sets the precedent/standard for private health insurance. It would be helpful in dealing with private insurance companies to obtain Medicare's prerequisites for covering ADR.

(3) It seems to me that one of the strengths of this forum is that people from across the country can realize that they have the same insurance companies--a gift of the Internet. It would be helpful to have some compilation of members' insurance companies and their success or lack of it.
(4) If there are knowledgeable lawyers amongst us, would it be possible for members covered under the same insurance company to file some joint action?

[NCFUSED]

With UHC, my 1st appeal was denied by a Diabetes Specialist, My second appeal was denied by a
Doctor who was out of practice for at least 10 years. He did actually call my Neurosurgeon, but had his mind set on NO from the 1st second of the conversation. Insurance Reviews are a joke....

[BRENDAWY]

Insurance companies policies vary from state to state even though they may all be BC/BC or Cigna. The big question is this, If the surgical proceedure to implant the device is experimental then why are other companies paying? Why is it not experimental across the U.S. They cant have their cake and eat it too. Our premium money goes in part torwards new technology, so why then cant we have it? How is it the FDA approved a device you cant use? I think i will ask them. BRENDAWY