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Insurance Hell All insurance-related matters are here: Medicare, worker's compensation, appeals, denials, insights, wins, losses. PRICING is here too. Note: This forum has posts from 2006 forward. Older ones are in the Big File.


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Old 02-03-2014, 05:51 PM
VegasGuy13 VegasGuy13 is offline
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Join Date: May 2013
Posts: 13
Default California State Law on Initial Denials

What I am trying to find is if there is a state law or regulation in California as to who is allowed to approve or deny a request for medical services. The appeals process states that the person must have knowledge and experience in this particular area--I cannot find anything about the initial decision. I want to quote something in my appeal that the doctor who made my initial decision was a family physician. I know many other states do have laws to this effect. Would appreciate any help on this you can provide.

Thanks
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Old 02-16-2014, 08:52 PM
femalepowerlifter310 femalepowerlifter310 is offline
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Join Date: Feb 2010
Posts: 100
Default Call the state

I'm about to do same for my knee surgery being denied. They denied my back 4 years ago too, but had clinical trial ADR so never pursued this.

California State Ins Board
916-255-2391


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Originally Posted by VegasGuy13 View Post
What I am trying to find is if there is a state law or regulation in California as to who is allowed to approve or deny a request for medical services. The appeals process states that the person must have knowledge and experience in this particular area--I cannot find anything about the initial decision. I want to quote something in my appeal that the doctor who made my initial decision was a family physician. I know many other states do have laws to this effect. Would appreciate any help on this you can provide.

Thanks
__________________
-FPL310
Cervical problems beginning 1984 (age 12)
*Hypothyroidism also started age 12 (may be related)
L4-5 herniation 1989
Years of Chiropractic allowed me to become a world class athlete in spite of this.
Cedars Sinai / Dr. Rasouli opinion Jan 2010
Axiomed Freedom Disc *clinical trial* - Feb 22, 2010
7 years later, Dr. Rasouli (my savior) had predicted with great accuracy when I'd need 2 level cervical ADR
Sept 29, 2017, became owner of 2 Prestige LP discs C5/6 & 6/7.
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