California | Health Care Law
Legal Question
After an ''Independent Medical Review,'' I only received a partial reimbursement
The Dept. of Managed Health Care ruled in my favor during an Independent Medical Review (IMR), overturning my health insurance denial of a medication, & deemed that it had been prescribed as ''medically necessary.''
However, after the ruling & I submitted the receipts that totalled $60,000 for a retroactive reimbursement, my health insurance company wrote and said they would only cover half of the monthly quantity. Despite a follow-up letter from my physician again stating the quantity I was stabilized on, they only reimbursed approx. $ 30,000.
1) Is their a statue of limitations since I cashed their check (their was no statement that it constituted payment in full)? I received the check April 2003.
2) Does the insurance company owe me interest on the outstanding amount?
3) Did they renege on the ruling?
4) When I called my IMR ''representative'' for help, her response was that the monthly quantity ''sounded like a lot, and said I would have to make another appeal. I felt she was not impartial, did she not uphold the ruling. Can she be held accountable in some monetary fashion?
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Read More Answered By: H.M. Torrey |
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