Denied again

[Justin]

Have you appealed to your state insurance board yet????? That is usually "The Supreme Court" on the matter....

John

Don't be fooled into thinking that going to your state insurance board will automatically reverse the appeal once it is in their hands.

The only thing my state insurance board did for me was cut and paste the EXACT same document that BCBS sent me.

Good luck,

Justin

[annapurna]

Hate to tell you this, but, there are very few laws that I am aware of that require US insurance companies to pay for anything. The insurance system in this country is not a national plan designed to maintain and improve the health of the nation's populance, it is a BUSINESS. Insurance providers are private, not public. They can decides who, what, and when they will pay for anything and everything.

In order to introduce any kind of legally-binding "fairness" into the system, the government would have to step in and start regulating the industry just like they do (or used to do) with utilities. Personally, I think that the insurance business desperately needs some regulation for just the reasons you've given.

Although I have company-sponsored health insuranc for which my husband and I pay about $2500 per year in premiums, I do not really count on them to pay for anything other than routine check-ups. For the last five years, we have literally funded the majority of our own health care by taking advantage of the following:
*cash discounts - many clinics will give up to 50% discounts for cash pay patients, but only if you ask ahead of time.
*flex-spending and medical savings accounts - allows health care costs less than the 7.5% IRS limit to be paid for with pre-tax dollars
*Medical deductions - you'd be amazed at what is deductible for big procedures.
*"Run for the border" - In addition to having procedures done in Europe (ADR, four knee surgeries, and possibly cervical ADR), my husband and I are investigating excellent clinics in Mexico, where costs and currency exchange rates would permit us get whatever care we need with no insurance coverage.

I realize that, if you're really cash-strapped, these measures just aren't going to cut it. Unfortunately, in my experience, the insurance companies are just too powerful right now. Definitely try going through your insurance commissioner, though, since this probably represents the only "check" on the insurance system. Something else to think about (dirty trick that it is) is to find out if they've paid for ADR for anyone else, then threaten to sue for discrimination.

Best wishes, and sorry for ranting.
Laura