Independent Medical Review California Department of Insurance

[CindyLou]

I recall the nerve test just about the same as spotty14. My leg really jerked too. Painful, but not too intense. Nothing like a discogram, so I wouldn't worry about it much.

[Abbe]

Appeal book is done and bound! It cost me a small fortune to have printed up, tabs put in, and bound. I had 6 copies made and I have sent 4 of them out already. I sent one to the state for actually 3 requests:
1. Independent Medical Review
2. Physician Certification Experimental/Investigational Denials (Signed By Dr. Delamarter)
3.Request for assistance

My "Book" has approx. 140 pages and 10 tabbed areas. This is my last ditch effort and I feel like I have completed my masters thesis in putting together this book.

Laurie Todd and "Harrison" have been very helpful in their suggestions. It really helped me pull all of the research I had been doing together and organize it. All I can do now is wait for the sh.... to hit the fan and we will see what happens if anything....

Abbe

[marilyn michalak]

We are all being denied healthcare, or the payment of by insurance carriers. It will take more than one person with immaculately bound records to break "the system" , I fear. Having been through the workman's comp mess, and the Erisa nightmare, I can honestly say that the insurance companies all use the same "techniques" to wear us down, wear us out, and end the end, they "win" because we are sick and they have more money. The most effective tool they have is to "drown" us in paperwork. And then they send you to "Independent Medical Exams" of their own. With their own doctors. They are not independent. They are paid assasins. Then come the films. If you can get out and actually take a walk one day, they will be there to film it. They will say, "look there's some one just fine, taking a walk". One good picture is all they need, in today's climate, to ruin your credibility. A judge will easily write it off. Just one picture. Your life may be filled with pain, but they will deny your claim and your credibility with the most innocent sunny day's walk, or stumble. Be aware that that picture is the next step. The insurance industry routinely hires private detectives to do the dirty work of filming. It happens as a matter of business, and be careful what you do.
Marilyn Michalak
Back Hell 8 years and going

[marilyn michalak]

By the way, I have a copy of the films used against me. This is someone who is sick and stumbling around , trying to walk. I have three copies if anyone wants one.
You are in the system, be careful.
Marilyn Michalak
Back Hell

[Abbe]

HI again,
Well, I got a call from the California Department of Insurance and they told me our insurance would not be covered by them. The woman told me that Motion Picture is a self funded Insurance and that she could foward my book I put together to the Department of labor. Then a few days later I got a call from a very nice lady from the department of labor anf she told me that there was nothing they could do but ask Motion Picture for all the details from my denials and that different people were supposed to do each review and ask for all the material they used for their decision. I had asked for the information they based they last decision on and all they sent me was a cryptic email from Motion Picture medical director and someone at Blue Shiield. Blue Shield is our hospitalization through Motion Picture Health Plan. It did not look like there was any review just Motion Picture medical director finding out from Blue Shield that they did not want to cover it. In the mean time I got the new "Plan" from Motion Picture and now as of July 07' ADR is mentioned specifically as not being covered under this plan. I guess I am S--- out of luck! The only this I can do is sue in Federal court, or find a way to pay out of pocket, go ahead with the fusions at L5-S1 & L4-L5 leave L3-L4 alone or do nothing and live the way I am now...... sometimes not so bad. I am so confused and don't know what to do.

Abbe

[ZorroSF]

I think the real question is CAN you afford to pay out of pocket and pursue that insurance institution 6 months post-op.

it's going to be a long and rough ride no matter what you decide. Another question is whether your insurance will pay the hospital bill. If you can get pre approval for the hospital bill then you'll have no problem getting the surgery. Of course if you use delamarter then you're paying the whole doctor bill out of pocket first and he will charge your insurance later. He can charge an outragous amount, so be careful. There are plenty of good surgeons here in LA.

On the other ahnd, if you can afford Delamarter to be your surgeon, then you can afford to go to germany.

Abbe;

Sorry about your insurance woes. Not that this will make you feel better but I got denied by UHC. I had to call to find out if I was denied. Today, I find out from my doctor's office that the reviewing doctor from UHC agrees it is the best procedure for me but since my company is self-insured he cannot override the program. His message told my doctor that he did not need to call back because he was just calling because he was required to do so. My doctor did call him back but I have no idea what was said.

In addition to this my husband's policy has a clause that states they will pay for an unproven procedure if it is less expensive than another approved procedure and that it will not set precedence. His boss is a chicken _____ and will not go against the company so he will not approve the override.

That leaves with a two level fusion or preparing for a trip to Germany. Right now I am leaning towards the fusion because I am tired of dealing with the ugliness of insurance. I need to focus on getting my life back.

Best of luck in finding relief.