|
We live in Colorado, and I have to say that the health insurance regulations in Colorado had been very good. My first rheumatologist (who unfortunately closed her practice) did the BEST thing for me. She printed out the state law that governed my rights to treatment. At that time, if your doctor recommended a treatment, there were several levels of appeals with which to get it approved. The top level of appeal was that your health insurance provider had to pay an independent doctor out of their own pocket to review the case and make a determination on whether or not the treatment was appropriate. So, basically, if it was appropriate, eventually it would get covered.
I had a health insurance provider (who shall remain nameless) that I just could not stand! They would deny my Enbrel at random times (usually once or twice a year, but not at regular intervals). It never failed that they would deny it when I was totally out of shots (or during 9/11 when you couldn't get it shipped to the pharmacy). Anyway, my rheumatologist would have to write a letter as to why I needed the medication and fax it to them. Under the law, they had 48 hours in which to respond. This health insurance company NEVER responded within that 2 day period. So, I would call them up on the third day, tell them that they had violated my rights under Colorado Statute yada yada, and it would be approved instantly. Problem solved in 3 days or less!
Well, now I know Colorado has made some changes, and to be honest, as new mom and "Attempted Webmaster Extraordinaire," I haven't figured out the changes. I don't think they are for the better though, given my conversations with my current health care provider on the phone (they consider detailed ultrasounds "experimental" and wouldn't cover one of the two I had. Don't ask me why because even they can't give me a straight answer.)
Anyway, if you live in Colorado, here is a link to read your rights. It's important! Do it!
http://www.dora.state.co.us/insurance/regs/4-2-17.pdf
|
