Getting the Help You Need in the Appeals Process
Know your rights as a healthcare consumer for….
- your healthcare benefits: what is allowed and disallowed
- consult your physician for medical necessity
- be your own advocate by filing grievances
You have rights under federal and state laws, to pursue coverage that you need from your health plan.
Positive VNS Therapy Appeal Outcomes Level 1, 2, or 3
The following table (updated as of 8/25/2008) provides 372 positive appeal outcomes for VNS Therapy for treatment-resistant depression (TRD). The denials by Healthcare Plans were overturned during a Level 1, 2, or 3 appeal process and by External Review Boards in various states. These positive outcomes occurred because patients and physicians felt strongly about the medical necessity of VNS Therapy for TRD treatment.
State | Primary Payer | Approval Date | Status Reason | | Healthnet, Inc. | 1/11/2006 | Denial Overturned | | Premera Blue Shield of WA | 10/25/2006 | Denial Overturned | AL | BCBS of AL | 3/20/2006 | Denial Overturned | AL | BCBS of AL | 3/23/2006 | Denial Overturned | AR | Novasys | 2/3/2006 | Denial Overturned | AR | QualChoice | 4/27/2007 | Denial-employer overturned | AR | HealthScope Benefits | 2/13/2008 | Denial Overturned | AZ | BCBS of ND | 2/17/2006 | Denial Overturned | AZ | BCBS of MN | 1/25/2006 | Denial-IRO overturned | AZ | United Healthcare | 4/17/2006 | Denial-employer overturned | AZ | BCBS of AZ - Corporate | 4/24/2006 | Denial-IRO overturned | AZ | Benesight, Inc. | 5/10/2006 | Denial Overturned | AZ | Banner Health Plan | 5/19/2006 | Denial-employer overturned | AZ | Aetna US Healthcare | 6/8/2006 | Denial Overturned | AZ | State Compensation Insurance Fund | 6/15/2006 | Denial Overturned | AZ | Administrative Enterprises, Inc. (AEI) | 7/18/2006 | Denial Overturned | AZ | Harrington Benefits | 9/20/2006 | Denial Overturned | CA | Medicare | 8/16/2006 | Denial Overturned | CA | CA Medicaid (MediCal) | 8/24/2006 | Denial Overturned | CA | Kaiser Foundation Health Plan | 8/18/2006 | Denial-IRO overturned | CA | CA Medicaid (MediCal) | 4/11/2006 | Denial Overturned | CA | Writer's Guild Health Plan | 11/15/2005 | Denial Overturned | CA | Healthnet, Inc. | 12/16/2005 | Denial Overturned | CA | Federated Mutual Insurance | 3/26/2007 | Denial Overturned | CA | Medicare | 3/28/2007 | Denial-IRO overturned | CA | Delta Health Systems | 4/9/2007 | Denial Overturned | CA | United Healthcare of CA | 9/5/2007 | Denial Overturned | CA | ILWU - PMA Welfare Plan Benefits | 9/24/2007 | Denial Overturned | CO | United Healthcare of Colorado | 1/9/2006 | Denial Overturned | CO | United Healthcare of Colorado | 9/27/2006 | Denial-IRO overturned | CO | United Healthcare of Colorado | 10/11/2006 | Denial Overturned | CO | United Healthcare | 1/4/2007 | Denial-IRO overturned | CT | Connecticare Inc | 10/20/2006 | Denial Overturned | CT | BCBS of MA | 11/2/2006 | Denial-IRO overturned | CT | Connecticare Inc | 10/4/2006 | Denial-IRO overturned | CT | Anthem BCBS of CT-Northeast Region | 8/11/2006 | Denial-IRO overturned | CT | Connecticare Inc | 7/24/2006 | Denial-IRO overtur |
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