IMEDECS
I am looking for the correct place to post for help trying to navigate the process of appeals for insurance companies.
I am a 33 year old woman who has been fighting Crohn’s disease for the past two years with really terrible inflammation that multiple doctors have had trouble getting under control. My doctor has requested an increase from Stelara medication every 8 weeks to every 4 weeks and my insurance does not want to pay for it. I’ve met with two nutritionists, 4 doctors, had countless appointments, a crazy limited medical diet, all sorts of things to get this inflammation under control, and my doctor seems very confident that this increased Stelara medication is the only way.
I received a letter, late on a Saturday afternoon from IMEDECS stating that they are an independent medical review organization approved by NYSDFS to perform external reviews, but that they only have 3 days to render an opinion and so I only have 24 hours to fax them documents to support my case.
What sort of documents should I submit? It says documents can be submitted by my doctor or by myself. How can I ensure that my supporting documents are even reviewed, being that they are giving me 24 hours, the letter they sent is dated December 8 and I did not even see it until December 11.
It sure seems like my insurance company hired someone to conduct this review that is biased against a fair outcome because they don’t want to pay for the treatment I need. I don’t know what to do.
submitted by /u/furyfireandblood
[link] [comments]IMEDECS I am looking for the correct place to post for help trying to navigate the process of appeals for insurance companies. I am a 33 year old woman who has been fighting Crohn’s disease for the past two years with really terrible inflammation that multiple doctors have had trouble getting under control. My doctor has requested an increase from Stelara medication every 8 weeks to every 4 weeks and my insurance does not want to pay for it. I’ve met with two nutritionists, 4 doctors, had countless appointments, a crazy limited medical diet, all sorts of things to get this inflammation under control, and my doctor seems very confident that this increased Stelara medication is the only way. I received a letter, late on a Saturday afternoon from IMEDECS stating that they are an independent medical review organization approved by NYSDFS to perform external reviews, but that they only have 3 days to render an opinion and so I only have 24 hours to fax them documents to support my case. What sort of documents should I submit? It says documents can be submitted by my doctor or by myself. How can I ensure that my supporting documents are even reviewed, being that they are giving me 24 hours, the letter they sent is dated December 8 and I did not even see it until December 11. It sure seems like my insurance company hired someone to conduct this review that is biased against a fair outcome because they don’t want to pay for the treatment I need. I don’t know what to do. submitted by /u/furyfireandblood [link] [comments]Read Morer/HealthInsurance