Re: Amy-peer review articles...long

[Guest guest]

,

WOW! What a great job you did and it looks like lots of homework!! Your so

nice- and how lucky this group is to have such a great team player like

yourself!!! Another rockin' mama to add to the list

' Mom

[Guest guest]

Amy,

I just want to add a comment about the AMA resolution. I think it's a fantastic document, and if I worked for an insurance company, that would be all I needed to approve band coverage. But then again, I have a clue!!! Anyway, we used the AMA statement in all of our appeals, but Cigna never mentioned it in any of their denials. As you may already know, we had our external appeal denied last week, and the doc who wrote the denial made the following comment: "The enclosed AMA resolution 119 was not introduced or backed by the American Academy of Pediatrics or any of the neurosurgery professional societies." I just want you to be aware that they will try to twist things to work for them. When we make our appeal to the Employee Benefits Committee, we may say that although these organizations have not backed the AMA resolution, the doctors who belong to these organizations are generally members of the AMA, and as such they should follow their resolutions. I hope I'm not sounding pessimistic. I just want others to benefit from my experience, and believe me, I have a lot of experience being denied. JGood luck with your appeal.

Gail, Sam and Sara's mom, DOC grads

Amy-peer review articles...long

There was also a Resolution from the AMA listed at the Plagio site that stated "children who do not have birth defects and facial anomalies repaired face long term physical and psychological injuries""treatment of a minor child's congenital or developmental deformity or any disorder due to trauma or malignant disease should be covered by all insurers, and that such coverage shall include treatment, which in the opinion of the treating physician is medically necessary, to return the patient to a more normal appearance, even if the procedure does not materially affect the function of that body part..."I think the AMA one's really important to point out since insurance co's. should follow their guidelines. I wish you the best of luck., 's momSouthern California

[Guest guest]

I can't take all the credit. Half the research I

found in the Coventry Appeal letter listed in this

group's site. I'm just glad I can be of help to

someone else since this group's been so helpful to

and me.

, 's mom

Southern California

--- rella1234@... wrote:

> ,

> WOW! What a great job you did and it looks like

> lots of homework!! Your so

> nice- and how lucky this group is to have such a

> great team player like

> yourself!!! Another rockin' mama to add to the list

>

>

> ' Mom

>

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