Welcome to my "Medical Denials" webpage...
Welcome to my "Medical Denials" webpage...
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On Monday, April 8, 2019, approximately 3.5 weeks ago, I had an appointment with my Orthopedic Surgeon to discuss my left arm.
- Sharp pain and loss of strength in shoulder area that has been treated with Acupuncture. That is only working for pain management. No long term healing at this time
- Mass of tissue in my humerus area presumed to be a partially torn bicep or deltoid or other
- Sharp pain around the outer edge of the elbow. In conjunction with mass of tissue, possible partial bicep tear from the elbow area
- Bony protrusion in inner elbow that is extremely sensitive
- Known issues with Ulner Entrapment that had been documented medically in 2014 but never formally addressed.
- Hand weakness, tingling and cold hands in several different areas depending on day
My left arm. I have a high pain tolerance, but it's being maxed out...
Left inner elbow...
On Monday, April 8, 2019, I walked out of a treatment room with my Doctor with a request for two MRI's. One for my LEFT shoulder and one for my LEFT elbow. I passed those to his medical assistant for processing, which typically takes 24-48 hours for approval.
On Wednesday April 10, 2019, a request for two MRI’s, one for my LEFT humerus and one for my LEFT elbow shoulder were sent to Blue Shield. This approval process is typically a 24-48 hour process.
On Wednesday April 17, 2019, seven days after the request had been submitted, I called my Doctor's office to check on the status of the MRI requests and was told nothing had come back yet.
On Thursday, April 17, 2019, nine days later, two MRI denial letters were created by Blue Shield, Christine Cabrera MD and Todd Greenberg MD
- Each letter was from Christine Cabrera MD and Todd Greenberg MD together. Two people I’ve never seen nor met.
- According to Christine Cabrera MD and Todd Greenberg MD, I need to do stretches (pt, chiro, supervised home health) for four weeks.
- They also told me I needed to change what I do but they failed to tell me what that was.
- They also told me I needed to, use heat and/or ice or take medicines.
- Then, according to them, I have to tell my doctor that didn’t make me better and that seemingly will enable them to approve my MRI's.
- They do imply I could tell my doctor I’ve been doing this stuff in the past 6 months with no results WHICH I DID and I HAVE, to a far greater degree than they are asking for (details below)
- NOTE: This letter did NOT arrive until Friday, May 2, 2019, two weeks after it was written?
- NOTE: When it arrived I realized they had turned me down for an MRI on my right humorous, not my left --
- NOTE: I've been under the professional care of an Acupuncturist, a Chiropractor and Herbalists for years at no cost to Blue Shield, and they have actively been working to manage pain and repair my left arm with no long term gains thus far.
Left Elbow Denial
RIGHT Humerus denial when a left Humerus MRI was requested...
The rest of the "medical advice" from Christine Cabrera MD and Todd Greenberg MD
Given my Orthopedic surgeon is experienced, and given these have been issues we had our eyes on to address after other issues, and given he knows I manage an acupuncture office and that i have a long standing chiropractor that cares for me, it's hard to imagine he didn't include proper verbiage in the original notes to get these approved...
On Thursday, April 18, 2019 I was verbally notified that my MRI requests had been declined by employees in my Physicians office. Remember at this point in time I didn't have the letter, and the office staff did NOT realize they had declined me for a right humerus.
On Thursday, April 18, 2019 I took to Twitter to try to get some type of dialogue going with Blue Shield. They responded quickly and appropriately.
On April 22, 2019 Blue Shield Drafted two letters acknowledging my appeal for each of the two items.
Neither letter indicated what the denials were for, so I had no way to manage a denial for a right humerus when my left was a problem
These letters were received around April 25, 2019.
On Friday, April 26, 2019, the formal MRI denial letters dated April 17, 2019 arrived. That's when I discovered they denied me for a wrong body party.
I called my physician's office.
I discovered there was not only confusion about the body part on the behalf of Blue Shield, but there was confusion between my Doctor and the Authorizations person about how they were to follow up with Blue Shield.
I sent faxes/emails in to convey my problems to the Authorization person who promised she'd get with the Doctor and Blue Shield on Monday to see what needed to be done.
On Monday, April 29, 2019, my doctor spoke with Blue Shield. He was told what he needed to modify in his notes to meet a threshold for approval. He modified his notes and submitted those.
I was told that we should have authorizations in 24-48 hours.
On Friday, May 2, 2019, I called my doctor and discovered an authorization for the elbow had been issued, BUT the authorization for the shoulder had been denied...
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