Just curious
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'
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!
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'
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
Again good luck
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