What is the best way to fight an insurance co that denies approval for a rhizotomy recommended by 3 mds? appeal letter sent; 2 peer:peer reviews done

Suggest: Understand your frustrations, as we physicians are constantly at odds with the insurance industry (which in my opinion, has been allowed too much control and abuse!) your state will have an insurance commissioner, who should investigate this. A consumer oriented lawyer might provide advice and counsel. You could demand an independent medical exam, and you could also get med school eval done.

Keep fighting: The only way to win is to persevere. This is a stare down competition the first person to look away loses. It sucks that it takes all this effort, but it took me and one of my patients almost 1.5 years to get procedure approved. We never waivered and obviously the treatment helped and was appropriate for care which inevitably helped. Good luck!

Follow the Rules: There are various levels of appeals. Each State has rules that can be followed to appeal insurance decisions. These rule can be tracked down by going to the National Association of Health Insurance Commissioners; see http://www.naic.org. If the insurance is self insured that the Dept of Labor governs the appeal process and rights,See: http://www.dol.gov/ebsa/healthreform/regulations/internalclaims