Re: Department of Managed Health Care?? Anyone with experience

[Guest guest]

Steve,

I am sorry to here about your 3X denials. Can you give us more

details. What state are you in? Is your company fully insured

through BC, or are they self-insured. If your employer is self-

insured then state laws do not apply, but Federal ERISA laws do. Are

you in an HMO or PPO?

Was the reason for your denial due to: 1) Exclusion, 2) Lack of

medical necisisty, 3) The DS being investigational.

Can you change insurance companies?

Each of these factors affects what the appropriate path is at this

point.

Hull

> Hello all. I've been denied 3'Xs for DS surgery now. I move on to

the

> Department of Managed Health Care....Anyone have any experience

with

> them??? they will accept my request and review it. I am a little

> fearfull to turn it in to them as I may leave something out, & if I

> turn in too much will they even read it? Also, what I believe I

need

> to turn in....was already turned in to Blue Cross and heck if they

> denied it.......I'm curious what have I left out that would educate

> the people making the decisions?

>

> Does anyone know the best way to proceed with the DMHC?

>

> Steve G.

> sign me worried and antagonized by B/C