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And The Fight Begins.... NY
#10
(06-24-2019, 07:37 AM)tbear6410 Wrote: He posted on the Patient Portal... same with the MG-2.. and the Denial...

He has listed there is 4 discs involved (not 1), listed the pinched nerves are causing more problems with both hips, numbness down both legs, burning & tingling down both legs, the fall down the cellar stairs due to legs giving out, if this continues, I'll be in a wheelchair due to the damage not being fixed.... And they still deny procedures... Biggie with the MRI is to compare it to one taken in 2017 and prove there is more damage.. They'll pay for an x-ray but that doesn't show nerves... wonder if he put in for a EMG for lower back/tailbone area if they'll approve that....

So sorry for what you are going through.

I am not familiar with your states utilization review process. I am trying to understand why the heck your treatments are getting denied. In my state doctors who include information in the patients records but do not include it in the treatment request often times get denied. In fact I believe this is the number one reason why treatment is denied in my state. The utilization review doctors do not get sent the patient entire file and usually only review the treatment request and sometimes the last 6 months of records. I don't know if this type of thing is happening with you, but it is VERY common here in California. UR doctors receive a request for MRI for example and the request does not give any reason for it or treatment guidelines, or enough reason.

I trust doctors, but verify by requesting the request they sent to the insurance carrier. I found often times they are not requesting the test or treatment with any backup. Again, I don't know if this is happening in your case, just wanted to mention, and also mention UR doctors usually do not go through patients entire medical file. They usually do high volume UR's and spend bare minimum on them from what I have read. Treatment requests need to contain everything needed (insurance carriers song and dance info they require to get authorization). I
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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Messages In This Thread
And The Fight Begins.... NY - tbear6410 - 06-13-2019, 01:54 PM
RE: And The Fight Begins.... NY - 1171 - 06-13-2019, 04:03 PM
RE: And The Fight Begins.... NY - 1171 - 06-14-2019, 01:26 PM
RE: And The Fight Begins.... NY - 1171 - 06-14-2019, 03:27 PM
RE: And The Fight Begins.... NY - California_Help - 06-24-2019, 01:34 PM
RE: And The Fight Begins.... NY - 1171 - 08-14-2019, 01:34 PM
RE: And The Fight Begins.... NY - 1171 - 08-16-2019, 12:31 PM
RE: And The Fight Begins.... NY - 1171 - 08-16-2019, 05:26 PM
RE: And The Fight Begins.... NY - 1171 - 09-06-2019, 01:59 PM
RE: And The Fight Begins.... NY - 1171 - 12-12-2019, 10:54 PM
RE: And The Fight Begins.... NY - 1171 - 01-08-2020, 03:18 PM
RE: And The Fight Begins.... NY - 1171 - 01-09-2020, 01:34 PM
RE: And The Fight Begins.... NY - 1171 - 06-18-2020, 12:24 PM

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