This person is absolutely correct. Some years back my wife was denied surgery for varicose veins. We filed a complaint with the state department of insurance and they ordered BCBS to pay for a second opinion by an independent vascular surgeon who said she should have had the surgery a year ago and was essential for her to remain alive.

Turns out the doctor at BCBS who denied her original surgery request was a psychiatrist. What a fucking joke.

Fascinating strategy. Thanks!!!

One of my doctors uses this strategy and is constantly complaining that his peer review is from a doctor in a different field. He is a vascular surgeon and one of my denials was done by a pediatrician. He always wins in the end, but it always delays things :-(

I might have to use this for Long Term Disability. They said they are reviewing my records to see if this was case of pre-existing conditions(which is only valid because I had just gotten the insurance 5 months prior and it's in the contract), it's not a pre-existing condition though!

I'm worried they will pit their doctor against the VA's doctors to say I can still work. Wouldn't that be funny.

My insurance provides coverage for gender affirming surgery but repeatedly denied coverage for my son to have mastectomy for gynocomastia. For god’s sake, he is just a boy wanting to be a boy who grew breast tissue because our environment and food is so horribly fucked up. He is a boy wanting to be a boy but that was not deemed medically necessary even though they will deem cutting off a young girls breasts or a young boys dick off medically necessary if they think they were born in the wrong body!

This is a great post. Can it be pinned for Frens to document results fighting the specific insurance companies denial of claims?

Excellent, thank you! It seems everyone’s strategy is to deny and make you fight for it. I think many insurance companies started to use this strategy to try to stop fraud, but now it is just a blanket denial for everyone. Instead of addressing the fraud, they punish the innocent.

I still think it's super weird that people can know how evil the medical industry is and yet they still go to them for every sniffle and hang nail they might get.

Why would anyone trust those people after they have shown their intentions to harm and even kill their "patients"?

Good post.

Getting my last few teeth extracted and graduating from a bottom partial to full dentures. Set an appointment with the oral surgeon, who called me back the next day.

Dentist Office: "I see you have Medicare Advantage,. We're not sure if they cover your extractions 100%, so you may have out-of-pocket charges."

Me: "I called my insurance company yesterday and asked them. They cover them all 100%."

Dentist Office: "Oh, okay, that's good. I see we'll be giving you Nitrous Oxide. You probably didn't ask them if that was covered. Did you?"

Me: "Actually, I did and it is also covered 100%."

Dentist Office: "I see. Well just so you know, insurance companies often have strict guidelines on anesthesia, so it's possible you may have some out-of-pocket charges on that. We'll just have to see."

Me: "Well, I'd better not, because my insurance company assured me that everything was covered 100%, so I'll want to see documentation. But thank you for calling."

I absolutely believe they do shit like this to test the waters for a chance to double bill their patients.

Seems like great information, thanks.

Excellent Post! Many thanks - screen capped & saved 🍻👍

Brilliant.

Another point: How can a long-distance doctor make a diagnostic decision without ever seeing the patient in person? How could such a decision be superior to the doctor who did see the patient in person?

Impossible.

A courtroom jury would likely agree, if you want to go there.

What to do instead - eat carnivore/Ketogenic. Know before going in that the first few days to weeks May be a little rough as the body switches from burning carbs for fuel to fat. Look for an electrolyte drink or take some salt when you feel a little off. You will lose water weight at first but once stabilized it will be awesome. Clear head. No brain fog. Weight loss. Joints stop hurting, more energy. Multiple people report disease disappear and health returns. Things like MS, diabetes, fibromyalgia etc. Your experience will be your own. Best thing - doctor and his clinic is in your rear view mirror. Oh and if you are willing to eat liver ….eat up or grab a supplement. Reference De Darren Schmidt, Dr Ken Berry, Dr Shawn Baker, Homestead How, My Zero Carb Life etc. Steak and Butter Gal.

Bookmark, ty fren

I'm glad my insurance pays almost everything for my immunotherapy treatments. The doctor bills almost $30,000, and I only have to pay $10. I think that's pretty good. And everything the oncologist has requested has been paid on by insurance. Somehow, CT, MRI, and PET scans cost me $100 each, so I haven't had a lot of them.

If my insurance ever turns, I'll have to use this information.

Place I work with just uses CCR to go down a check list for prior approval, no clinical background needed. Perhaps its reviewed by someone clinical but that's not what I was told.

Example they use to deny stuff is FDA standards. So a lot of experimental stuff is flat out denied because of it, in fact most denials is because drs are prescribing it in an experimental way from what I have worked with

Does this work for Medicare also?