Count me in the crowd screwed by employer's insurance carrier. A little advice. When the carrier contacts you, they have 45 days pet Erisa to have an initial decision. This can be extended at the request of the claimant for another 45 days.
When I spoke to them, I told them I couldn't get the neuro functional assessment until a specific date which was after this date. I was told no problem, take them then. They went ahead and reviewed claim with one office visit, which lacked dentail and my neuropsych assessment.
Based on this they denied. When I called back, they said no problem, I cold send these in after my appt still. Of course what they didn't tell me was it would then count as my appeal. I told them I wasn't going to rush it then, as I want my full record included. They then offered to rushy review so that another decision could be made by the eligibility date for payment ( a few weeks). Scare tactic for loss of employment. Once again, would have been my appeal review. Finally, last tactic was to offer to pull my PT progress reports and review.
They tried every trick to get me to rush appeal review. Thankfully, I talked to my lawyer before this and he warned me of each tactic. I told them it would be handled with benefit of counsel and that I felt extremely misled on how they handled my claim. Good thing is that lawyer thinks I can add that to the appeal as further grievance. I guess the next 180 days will be painful.
When I spoke to them, I told them I couldn't get the neuro functional assessment until a specific date which was after this date. I was told no problem, take them then. They went ahead and reviewed claim with one office visit, which lacked dentail and my neuropsych assessment.
Based on this they denied. When I called back, they said no problem, I cold send these in after my appt still. Of course what they didn't tell me was it would then count as my appeal. I told them I wasn't going to rush it then, as I want my full record included. They then offered to rushy review so that another decision could be made by the eligibility date for payment ( a few weeks). Scare tactic for loss of employment. Once again, would have been my appeal review. Finally, last tactic was to offer to pull my PT progress reports and review.
They tried every trick to get me to rush appeal review. Thankfully, I talked to my lawyer before this and he warned me of each tactic. I told them it would be handled with benefit of counsel and that I felt extremely misled on how they handled my claim. Good thing is that lawyer thinks I can add that to the appeal as further grievance. I guess the next 180 days will be painful.
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