Quantity Limits

[saberdesktop]

My insurance company has imposed Quantity Limits on an antibiotic I take for Chronic Lyme Disease. I must fill the RX every 6 days despite being prescribed the medication for 30 days on an ongoing basis. I went through appeals procedures last year that went as far as the Maryland Insurance Administration (MIA)and at that point my carrier approved 2 months of the meds at 30 pills at a time. After the 2 months they denied extending it once again so I initiated a second appeal. This has once again gone through the MIA where it was put through an independent evaluation and denied on the basis of not being medically necessary. I have initited a hearing but am unsure of the merit/basis going forward. I don't understand how this can be deemed not medically necessary when they are allolwing the medication but just restricting the quantity. Also, they based their denial on ISDA (Infectious Disease Guidelines) however these guidelines have been called into question by the Connecticut Attorney General due to conflicts of interest within the organization and he has called for the assembling of a new panel to revise these guidelines.

My question is do I have a legal basis to appeal my carrier's denial? Obviously this is not a significant monetary issue as much as it is an issue of prinicple and the hassle of filling an RX every 6 days. I don't want to incur legal expenses and would very much like to enter into mediation, but don't want to do this without being somewhat prepared. Any thoughts on this would be appreciated.What is the name of your state (only U.S. law)?