If you're appealing for a DS

More info that might be helpful to some -- the CA DMHC has been overturning decisions of CA HMOs for patients wanting the DS over the RNY, including in the last few months those with BMIs less than 50! Check the list below to see if your external review is to the same organization that reviews for the CA DMHC: The CA Department of Managed Health Care is the part of the CA Dept. of Insurance which hears complaints and appeals against CA HMOs. It is a state agency. It actually sends the medical appeals to a contracting company called CHDR (Center for Health Dispute Resolution) (http://www.maximus.com/corporate/pages/CHDR.asp), which is division of the company called Maximus. CHDR also reviews appeals to the CA Dept. of Insurance from PPOs -- it's a very odd setup in CA -- you send appeals to different groups at the CA Dept. of Insurance, but they get funneled to the same reviewers. "MAXIMUS CHDR is the nation's leading independent medical reviewer of disputed health insurance claims. CHDR serves more than 25 states in the role of reviewer of appeals made by health plan enrollees. We also are the official Medicare Managed Care Independent Review Entity for the Federal Centers for Medicare & Medicaid Services (CMS). We serve in a similar capacity for the federal Office of Personnel Management (OPM), reviewing claims disputes in connection with the Federal Employee Health Benefits Program (FEHBP)." So they also review MEDICARE and MEDICAID appeals, and Federal Employee appeals -- good news there too! AND also from the CHDR site: "CHDR Clients *Centers for Medicare & Medicaid Services (CMS), Independent Review Entity (IRE) for the Medicare Managed Care & PACE Reconsideration Project *Office of Personnel Management (OPM), Federal Employee Health Benefits Program (FEHBP), Dental Medical Review Services, and Medical Review Services *State of Alaska, Department of Administration, Division of Retirement and Benefits *State of Arizona, Department of Insurance *State of California, Department of Managed Health Care *State of Colorado, Division of Insurance *State of Connecticut, Insurance Department *State of Florida, Agency for Health Care Administration, Bureau of Managed Health Care *State of Georgia, Department of Community Health *State of Indiana, Department of Insurance *Commonwealth of Kentucky, Department of Insurance *State of Maine, Department of Professional & Financial Regulation, Bureau of Insurance *State of Maryland, Insurance Administration *Commonwealth of Massachusetts, Department of Public Health, Review Agencies for Managed Care and Board of Registration in Medicine *State of Michigan, Department of Consumer and Industry Services, Office of Financial and Insurance Services *State of Minnesota, Department of Administration, Department of Commerce - Enforcement Division and Department of Human Services *State of Missouri, Consolidated Health Care Plan, ERO Self-Insured Health Benefits Plans *State of New Hampshire, Insurance Department *State of North Carolina, Department of Insurance *State of Ohio, Department of Insurance *State of Oklahoma, Department of Health *State of Oregon, Department of Consumer and Business Services Insurance Division *Commonwealth of Pennsylvania, Department of Health Bureau of Managed Care *State of Rhode Island, Department of Health *State of South Carolina, Department of Insurance *State of Texas, Department of Insurance & Texas Worker's Compensation Commission (TWCC) *State of Vermont, Department of Banking, Insurance, Securities and Health Care Administration Division of Health Care Administration *Commonwealth of Virginia, Department of Personnel and Training Office of Health Benefits and State Corporation Commission Bureau of Insurance *State of Washington Department of Health *State of Wisconsin, Office of the Commissioner of Insurance (OCI)" Diana

Diana, You are a gem! Fern B.