Question:
Does any one have any experiance with the department of managed heath care?
I was denied by Kaiser and am now working with the department of Managed Health Care to get denial over turned I was wondering how many people have gone throught them and what there suceess rate is. Any input appricated thanks Kathy — kathy B. (posted on August 1, 2002)
August 1, 2002
Hi Kathy, I had a IMR with the DMHC! Kaiser's denial was overturned. The
DMHC is the best. If you meet NIH guidelines you will get approved. Check
out http://wp.dmhc.ca.gov/imr/display.asp Type "Obesity" in the
search line and you will see the outcomes of all the IMR decisions. You
will find most WLS are overturned and the ones that are not are usally
upheld for "type of surgery" rather than approving WLS. Look at
http://www.dmhc.ca.gov/imr/stats.pdf and you will see of all Med necessary
IMR's 2/3 are upheld and 1/3 are overturned. However at one point I
counted all WLS decisions and all but 2 were overturned. Odds are in your
favor, especially if you fit NIH guidelines. Best wishes.
— ERICK B.
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