Seeking ADR...my story

[jessmith07]

Runner,

I'm so sorry to hear of your ordeal, yet it makes me feel even more blessed to have fought and won. I know that I'm among the fortunate few to get the insurance company to approve this. I just hope that the more people that fight and win and share their stories of how they did it, that hopefully, eventually, the industry will turn. I was fully prepared to go to the Office of Personnel Management in Washington, as well as the Department of Insurance in SC, whose job it is to help protect consumers against insurance companies. One thing I learned in my research is that HIPAA doesn't just protect your privacy...it's more than that form you sign at the doctor's office. HIPAA is a federal law protecting consumers from the corrupt insurance companies, and while it doesn't mandate that they MUST cover certain things, what it DOES mandate is that they can't discriminate treatment within a group. In other words, if you are in a group plan with 1,000 other people, and they cover ADR for someone else, but deny it for you, then they are in violation of federal law.

In Summary, HIPAA, Title IV looks something like this:

Group health plans may exclude coverage for a specific disease, limit or exclude benefits for certain types of treatments or drugs, or limit or exclude benefits based on a determination that the benefits are experimental or medically unnecessary - but only if the benefit restriction applies uniformly to all similarly situated individuals and is not directed at individual participants or beneficiaries based on a health factor they may have. (Plan amendments that apply to all individuals in a group of similarly situated individuals and that are effective no earlier than the first day of the next plan year after the amendment is adopted are not considered to be directed at individual participants and beneficiaries.)