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Old 11-28-2004, 10:33 AM
travesty
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External appeal


What is the name of your state?RI

My insurance BC/BS is denying my medically necessary functional reconstructive surgery and saying it is cosmetic, my situation is very rare and encompasses less than 1% of the population. i worked on my appeal for 27 months before i requested services, and it was exhuastive 15 pages long, including sound medical evidence, court documents etc, i proved it was NOT cosmetic, and i believe they know it is not cosmetic and just dragging their feet, every medical docuement says my conddition warrants reconstructive surgery etc, well i am in the process of going to external appeals, here is the question i have 2 locations to pick from MassPRO or Health Center for Dispute Resolution (Maximus) can anyone point me as to the correct one? which of these two are the actual better location to appeal to? your help would be greatly appreciated as this will be my last appeal
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Old 12-01-2004, 12:41 AM
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If you are in an appeal situation, and the amount involved is significant, consult a lawyer in your area who is familiar with matters like yours. That lawyer will know which of the 2 forums is likely to be less unfavorable to a claimant and can also help you evaluate your presntation, even if s/he does not handle it at the possible hearing on the appeal.
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