Terrible Pre-Approval ProcessJan 10 2012
They actually denied a treatment claiming that it was not medically necessary and instead recommended something that was damaging. Apparently, the pre-approval process goes something like this...Board-certified surgeon recommends a course of treatment, recommendation is reviewed by NURSES, who in this case picked a cheaper course that would actually do damage. Reviewed recommendation is then forwarded to a Medical Director who is either not reading them or is under-informed. So now the burden of proof is left on the original physician.