Just curious

abuddingrose
on 9/21/09 1:37 am - Essex, MD

I am just curious has any one here ever dealt with the California Department of Insurance on appeals or independent medical reviews?  I have a request in to them for IMR and waiting to hear from them.  I am curious what kind of experiences people here may of had with them.

 

 

Thank you

 

Zells_lori is 'abuddingrose'

never settle for less than you deserve and you deserve only the best.                            
terryrow61
on 9/21/09 1:39 am - Garden Grove, CA
Sorry, never had to deal with either of them, but wish you the best of luck.
Terry
Monica P.
on 9/21/09 3:25 am - Long Beach, CA
RNY on 07/19/07 with

I have. I filed an appeal with them for my RNY two years ago.

The DMHC manages all the HMOs that operate in California and they are feared and respected by the insurace companies.  I was really fortunate with the timing of my appeal. It was at the same time my insurace company was reapplying for their license to operate in California.

Because of my case it brought to light that they were stalling and delaying approving WLS for its members. Within 24 hours of my case being opened at the DMHC, my insurance company was CALLING ME to make me go see my surgeon ASAP! They were on it!

 They are a pro-patient organization and if you qualify for surgery or your insurance company is acting shady, they will deal with it.

Good luck!

abuddingrose
on 9/21/09 3:37 am - Essex, MD
Monica:

Thanks a buch for the feed back.  I am glad to heare the DMHC went to bat for you and apparently you had the surgery that you needed/wanted.   I am not sure that DMHC is the the one that will handle my case.  I have a PPO and even though they are considered a hybrid between and HMO and another type of insurance.

I am waiting to hear from someone to see what is going to happen.

I am currently taking 10 meds a day and my blood pressure is getting harder and harder to control with medication.   Also my ortho feels he may have to do a total knee replacement  sooner than he thought.  but underprotest because of my size.  5 feet 5 inches tall and weight 265.

SO we will see what happens.   Hopefully someoen will see the writing on the wall and make a wise decission in my favor.

Again thank you for feed back

and thank you

Zells_lori is'abuddingorse'
never settle for less than you deserve and you deserve only the best.                            
Monica P.
on 9/21/09 3:47 am - Long Beach, CA
RNY on 07/19/07 with

If you're requesting an Independent Medical Review, most likely you are dealing with the Department of Managed Healh Care.

If you have an HMO, you are more likely to be approved since HMOs in California are required to cover weight-loss surgery. 

If you want to talk to a professional, I would suggest contactig my attorney who fought my case. The consultation is free and they can offer you a lot of free advice/information. www.obesitylaw.com

 

Diane C.
on 9/21/09 6:04 am - Highland, CA
Good luck with your case, I also wanted you to know that I was 5'8" and weighed close to 400, and my knee was replaced.  It worked out fine, and is just that much better since I have lost weight.  Don't suffer with a bad knee because of the weight issue, get it done.  My surgeon did mine, I recovered well, no problems, the only difference is now the replacement will last for 15-20 years as compared to 5 or 6.

Again good luck
Jackie717
on 9/21/09 3:45 am
Sending you positive thoughts that they see the freakin light and make the best decision for you!!
This surgery really makes such a change in our health and outlook on life.  Im wishing you the best!

Hugs,

jackie
Started Liquid pre-op diet July 2, 2009 / Surgery on July 16th, 2009
Starting weight: 385
Current: 245
First goal: 180

                
msblues
on 9/21/09 7:09 am - Santa Cruz, CA

I work for the state of California and know people are usually treated well on appeals for medical procedures.  If you want to find out the status of your case, don't try calling 800 numbers. Instead call your state Assemblymember or State Senator and ask their staff to help find that out for you. If you run into any problems or they are not getting back to you when they said they would, give them a call for that too. They have a direct line to a contact who only works with legislative staff so they can get the information in a much faster manner than going through the 800 number.

To find out who your representatives are, go to http://192.234.213.69/amapsearch/framepage.asp  and type in your address.

Good luck!

MsBlues

 

abuddingrose
on 9/21/09 7:13 am - Essex, MD
Ms Blues:
Thank you for the heads up.  I do have one question though. 

My insurance is governed by the state of California but I live in Maryland.  Any advise who I can contact to get a quicker route on updates for my case?

Thank for the information.

Zells_lori is 'abuddingrose'
never settle for less than you deserve and you deserve only the best.                            
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