I had my right mandibular removed due to cancer in 2002. [did not smoke or drink]. I appealed the policy on dental implants and the medical review board for the company I work for over turned their denial in 2003. The company changed insurance companies in 2004. I got the run around and was finally allowed to appeal them. I was also sent a letter stating I could have this done in 2004. The insurance company still would not let the doctors do this procedure. Mainly reconstruction of my jaw and implants. The doctors coded properly and twice sent preauthorization with no responses. I finally was allowed a second appeal. I was given the forms and sent the appeal in. I have proof of delivery but the insurance company said they misplaced the package. Finally after 2 months they sent another denial letter also stating this was the end of the administrative process, which is not true, I am allowed a third appeal which I did and sent it in. I have not heard back yet. A rep from the insurance company and the company I work for are to look at the appeal. I am sure I will get the same response even tho I have proof of delivery. I am not finding any lawyers interested in this and I feel I have a good case, since the insurance company has mishandled this whole appeal. I would send all this information to the ceo but am afraid I would lose my job, even tho my work record is good. I also requested, twice now, copies of the whole appeal case, which I am allowed to do with no charge to me. This company is a big company world wide.
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If you are in the US you can file a complaint with the state bureau (department) of insurance. You are a consumer and have certain rights. The state will investigate to see if your insurance company has mishandled your case.
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