California State Law on Initial Denials

[VegasGuy13]

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

[femalepowerlifter310]

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

Originally Posted by VegasGuy13

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