Does this sound like an impartial review?

HIGHMARK is who ICUBA is having handle my appeal!!! WTF? So I had e-mailed the admin and requested that I have a face to face or at least video conference with the external committee who will make the recommendation or Admin Board making the final decision. And she replies that the IMC, the people she will forward my appeal onto, are located in Pittsburgh and that a face to face would not be possible. Hmm...that's odd Pittsburgh is where Highmark is located and where I sent all my appeals. Wow is that ironic or is something fishy going on. So I google IMC and Pittsburgh...and guess what I find....http://www.imcdocs.com/services/other.html Note up in the upper left corner....an Affilate of Highmark!!!I have e-mailed her and asked why an afflilate of Highmark is handling any aspect of what is suppose to be equivalent of external appeal. That's it, I'm no longer playing nice...errr...not sure I ever was. But I am now having my friend contact a lawyer she used to work for, I'm afraid I will only get a fair and impartial hearing on this in court. It's a shame things have to go this far when my medical need for this surgery is so evident. I have sent them pictures, doctor letter, doctor chart notes dating back 2 years, prescritption records. I have no idea how these people can live with themselves, although I'm sure it's much easier given they have normal arms.

Oh Sarah, how frustrating. I'm sorry they are jerking you around. Have you called your State's Insurance Commission? They have lawyers there that you can speak to, and you can file a grievance. The state commission will investigate and hold your insurance accountable. Good luck, Kahlua

I've checked, in FL, the insurance commission only deals with HMO's, not privately funded insurances as mine it. My only recourse after this "impartial review" is to file a civil suit in court against all of them. I e-mailed the Department of Labor regarding ERISA and a guy called me back the next day and told me yep they don't intervene but I can file the suit siting ERISA.

ICUBA stands for the Independent Colleges and Universities Benefits Administrators, so I don't appeal to my employer per se I appeal to ICUBA but our HR contracts with them to do all our benefits. So to me if I have done all the normal appeal levels through Highmark BCBS, and my final appeal is suppose to be to ICUBA, how can I expect IMC to give ICUBA an impartial recommendation to ICUBA's board if they have anything to do with Highmark's bottom line...as for ICUBA also I have questions since they are looking out for their bottom line also...more claims mean higher costs to their self funded plan. I moving forward with the appeal to them, I just have little faith or trust that anyone will care more about my functional limitations and suffering than their pockets.

I understand your frustration. I also have a self funded plan and it's been a b*tch! I think they do this so we'll give up but keep your chin up and stay motivated. It'll work out.  Cathie

Hi Sarah-  I have UHC and when I called them to check on the status of my appeal I asked them if this was being reviewed by an "outside" source. I was to NO and they handle all of their appeals in-house!  Going round and round! Read my "latest posts" for more detail Hang in there! I plan to push for the benefits I'm entitled to!