Posted by: June W. ®
02/02/2010, 21:10:47
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My HMO turned me down for Dr. Berke's surgery, even though my Dr. (ENT they sent me to who does botox) referred me for it because botox injections aren't as effective anymore. HMO said there's no long term clinical data to support it and after Dr. Berke provided the data they still turned down appeal and said it's "experimental", etc. I had a referral from my primary Dr. at HMO, my ENT did appeal letter, Dr. Berke did appeal letter and provided a before and after DVD, clinical data, etc. I've worked hard on it and cooperated with all HMO said they needed and it's very frustrating. Anyone go through the same thing and can you suggest what avenues I have to fight it? I e-mail the Insurance Advocate's office (gov't.) today and am awaiting their reply (they say they've sent to proper dep't.). Any other ideas, and thank you.
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