So, she appealed through the Missouri Independant Physician Review. Five weeks later an anonymous Orthopedic Surgeon over-ruled the insurance company. They went back for me. They were thorough. According to the Missouri Department of Insurance, patients win one out of every three cases.
Some states are even more aggressive.
In January, Illinois launches a comprehensive health care reform law, which will speed up the appeals process and allow independant review of any denial. The closely guarded secrets of managed care are having a dramatic effect on many patients. Ask your doctors and HMO lots of questions about your condition and the most effective treatments available. Read your contract and understand what it means to you and your provider. Keep a file of mail sent by your provider.