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[quote=Anonymous]Have you appealed the denials and/or escalated the denials to exhaustion? I've found that it takes hours of phone calls and/or written submissions (from me and the dr.) to reverse a decision. I'm also a lawyer and I've had to fight tooth and nail for certain medication for my DD to be covered--and I have to go through this process every year (the medication is approved for a one-year period). Every year, they insist my DD try up to 3 different medications to "prove" she needed the one at issue even though her doctor submitted all the info explaining why this medication was unique, the reasons she needed that one, and despite the fact that she's been on it and it's working for her. After repeated calling and escalating it to managers and other senior team members--explaining that I cannot put my 10 year old on a drug trial to satisfy their random criteria when her own doctor prescribed it and it's working--I am able to get an "exception" and the medication gets approved. Although I'm fortunate enough that I can find the time to deal with all of this, it's sickening that anyone should have to go through all of this to get medical care.

My situation is different than yours but I share it in case it proves helpful to you. Every insurance plan is different and the procedures are different, but if you have the time to continue to fight, go for it. Given the amount at issue, I'm not sure retaining an attorney to pursue this makes sense (you'll pay more in legal fees than your out-of-pocket costs) but you could certainly pursue if you feel strongly about it (although I have no recs, sorry). GOOD LUCK!!! [/quote]

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