Victory!!!
After dealing with my insurance for almost a year, they have finally agreed to pay for my ADR.
I had the surgery in June '10. I agreed to pay out of pocket for it, but after the surgery filled my 4th appeal.
My insurance had made many mistakes along the way in the denial process and we made sure to highlight every.single.mistake.
We tore apart the medical policy. They told us that it had to go to an IRO. We made sure they sent everything. All medical records, all denials and our 44 page appeal we wrote.
IRO approved it!!! But that was not the final victory. Lifewise did not have to agree to abide by the decision.
Today I called, after they failed to return 3 other phone calls, and said yes, they would honor the decision and will start processing bills in the next few weeks.
Not only did we write a great appeal, but we kept record of the phone calls, all emails, all mistakes and anything else that would help us build a case. When our insurance company wouldn't do things properly we would quote Oregon state law in emails to them. I think they thought we had a lawyer.
Anyways, I live in Oregon. We have Lifewise, which is also known as Premera in other states. From all the research we found we are one of the first lumbar ADR's to be approved. We did find a Cervical that they had done a year or so ago.
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