Latest Update on CA Reconstructive Surgery (no medical necessity) law suit

What a stride Diana!  Fantastic!

Geez, I hate bureacratic bull.  I called the DHMC, gave the background on this, ask my very specific question and the answer I got was all about the "procedure".  In other words this person did not answer the "Medicare" question.  Then I read her this post with Diana's comments, and the numskull tells me to call Medicare.  I ask "why", I know they will deny the surgery...oh DUH.   So I backed up and started over again, telling this person I was not interested in the procedure for appeal or grievance.  I was interested in the enforcement of the CA statute; and my question is would they regulate my Medicare coverage.  The numskull then tells me she already answered that question, then asks if she can put me on HOLD.  I said "why, so you can LOWBALL me off to someone else and I can start over from scratch and get irritated enough to pull ALL my hair out?"  Yes, she wanted to give me to someone else, but thought she could just put me on HOLD and surprise someone else would appear on the line and she would be DONE with me.  So, forget that. Diana, where would I find a similar CODE in the Texas law regarding reconstructive surgery? 

It is unlikely there is one, but go to Law.com and do a search on ("reconstructive surgery" AND statute AND Texas) or something like that.  That's how I found the CA statute.

way to go, For Change, how about the vice presidency?

  Good Job, Diana!!

I got a copy of the TAG today, and OMGOD, Health Net (and every other insurance company in California!) is SCREWED!!

A couple of the questions that the consultant is to answer on the survey of the Health Net decisions:

"Do the plan's UM and/or medical policies inappropriately include a "medical necessity" requirement in their criteria to authorize reconstructive surgery?"  [emphasis in the original]

"Does the plan inappropriately require that a functional deficit is present in order to authorize surgery?"  [emphasis in the original]

This is TOO FANTASTIC!  All of their denials are for lack of medical necessity!!

It looks to me like CA insurance companies are going to have to come up with another excuse to exclude "reconstructive surgery".   Perhaps we are "too ugly" to be fixed.  Ya' think?