Our insurance denied some claims, because they apparently didn't understand that the injections performed by the doctor were *test* injections to evaluate the suitability of radio ablation, they seemed to think the injections were *treatment*. The doc wrote a letter explaining that the injections were diagnostic in nature to evaluate for possible treatment, insurance again seemed to ignore that, and sent the case to an independent review company, MMC.
Like the insurance company, MMC seemed to completely ignore what the doctor said, and denied the claims based on the injections being unnecessary *treatment*, when they weren't treatment, they were *test* (diagnostic) injections to *evaluate* for treatment.
That's my understanding from reading their ruling, which completely ignored what the doc said. If MMC actually understood the issue and took the doc's explanation into account, then they certainly didn't bother to address that in their ruling, so they would still get only one star for an incompetent response.
There is no more recourse available short of a lawsuit, and suing would cost more than we could hope to recover. MMC's incompetence cost us real money. read more