you can ask for an indepedent committee to review your medical history and make recommendations for the insurance company.

this may or may not work in your favor btw.

be sure to talk your insurance broker and find out who all the major player are in your insurance company and write them personal letters of complaint.

also ask the insurance broker what strategies may help you with resoltution of these charges.

if you keep pressing the insurance compnay they will eventually cave, they always do. they are counting on you to give up, you must have infinite patience and reserve.

Do not give a reason.

Do not accept 'no', as you are entitled to them anytime you ask.

They will assume you are filing a lawsuit and sometimes suddenly become much more cooperative.

Back when I lived in NJ, my insurance company dorked me on a HUGE bill (related to Lyme) and after going back and forth with them for a while, an advocate at a local hospital (who had nothing to do with any of this, she was just super kind), helped me file my claim with the state.

After six months, I received a determination in my favor stating that if the insurance company didn't pay the bill within 7 days, to let the department know because big bad horrible things would happen to the insurance company.

The whole process wasn't too hard, you just had to provide documentation of your side of the story and then patiently wait.

Anyway, that is something to check out.

Back in 1999 I claimed jaw surgery and Lyme IV antibiotics (which I had to get out of plan due to HMO misdiagnoses). When they said "NO" I stupidly followed them down the garden path to thier arbitrator - who upheld the denial on flimsy/insane pretexts. I was too weak to press the matter from there. My health came first.

In 2000-2001 I file another claim. When the denial arrivewd I took it to the state Dept of Insurance for arbitration - which upheld the denial but allowed me to see an ALJ. At ALJ hearing I got a level playing field. DOI then got on the HMO and it PAID.

In 2002 I filed $10,000 in out of network IV antibiotics. My HMO directed me to hoops and meaningless, adversarial delays and I never did get my claim upheld or denied.

At one point I was in limbo for 12 maddening months.

I called my senator, completed his privacy form and jumped through his hoops and GLORY BE he found out how my HMO abused me and turned on them!

And I GOT PAID.

40 months' effort BUT IT WAS WORTH IT as I recovered most of what they failed to pay 1998-2001.
http://www.harp.org/#fad
Insurance, Disability Claims, Health Costs, and HMO Issues and Lyme Disease

See link "fighting a denial" (Includes "HMO HARDBALL")
http://www.hmohardball.com/

"10 'Dirty Tricks'"
http://www.rescuehealthcareday.com/10DirtyTricks.htm

I have no idea how she got a hold of one but I'll send her an email right now and get back to you.

My neighbor used one when her daughter's claims were denied and she won.

Do you have a lawyer you could talk to and see what recommendations and legal adive they can give you?

I'd personally go after them from a legal stand point if you can afford to financially to make an example of them.

One thing you want to keep in mind with the Insurance Commissioner at least in the state I reside in is you need to keep hounding and calling them because in this state, the Insurance Commissioner is the biggest joke.

When we made it clear we were going to court, and that each denial would be treated separately (at one point, that meant the ins. co would have to make 6 separate court appearances), the insurance company paid our claims. We had thorough documentation, and they knew it. It took from 12 to 36 months for us to win our appeals.

Just be sure you have a thorough medical history and all your medical records. Get postal receipts on everything you submit. Document your physical limitations and not just your diagnosis. Cite the medical literature -- there is a wealth of information on this site, and at http://www.lymeinfo.net/lymefiles.html We got advice from an attorney, as well.

When you're sick and exhausted, this seems like a tremendous amount of work. But do one step at a time, and you'll get there.

They said they only did that testing for liver transplant patients.

I asked my doc for papers documenting why I needed the testing.

Bundles them into a large manilla envelope and spent a couple dollars on postage. There were so many papers that they just capitulated and paid with no ??? asked.

When going to a committe I suspect its a lot different.

Im hoping this might give you some bit of an idea or clue as to how to proceed.

which stands for "DISABILITY INSURANCE ISSUES" ... a wealth of good info there.

Go to their files/links & print off the screens shown...they will help you.

Print off the female drs. SSDI app..possibly 20 pages giving you specific ideas on how to word things showing you can no longer work using their 8 things: standing, walking, sitting, bending, crawling, hand jobs, etc.

Look at all the pertinent stuff BEFORE you decide to file your SSDI claim so it can be approved on the 1st step of your 1st claim only!

Read my today's topic on APPEALS COUNCIL denies me. I've been in this God awful mess for 4 yrs. 4 months without success.
Best wishes, Betty G., Iowa

See if HMO contract allows out of plan treatment for urgent conditions, too.

Some limit emergencies to "seconds count, rush-to-the-hospital" events.

I won my first HMO case at a hearing by reading their definition of "emergency" word for word. My jawbone infections was just that (I also had out of plan Dr. say it was emergency).

My HMO retorted that because they didn't treat my jaw infectinos when acute, the infections were chronic, not "emergent".

They also chided me for not getting my jaw surgerized sooner. It made complete sense to them but the Judge was not impressed.

good luck, guiney