UR approval, denied by Onecall (California)

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UR approval, denied by Onecall (California)

Postby doublecrush on Tue Feb 09, 2016 10:48 am

Need advice please. On 1/22 UR approved the replacement of my Spinal Cord Stim, and Leads. Devise reached EOS and 2 electrodes were no longer functioning. Everyone involved received received UR approval letter from Mitchell. Patiently waiting for scheduling 18 days with no calls. Followed up today with dr's office and they said they received a call (nothing in writing) from Onecall Care Management, denying the procedure and left it at that. Can this really happen and what is my recourse? Thank you.
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Re: UR approval, denied by Onecall (California)

Postby doublecrush on Tue Feb 09, 2016 7:52 pm

NEVER MIND!!
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Re: UR approval, denied by Onecall (California)

Postby Manila on Wed Feb 10, 2016 12:54 pm

Do you have the initial approval in writing? Do you have an attorney? Have you talked to the claims examiner or the claim examiner's supervisor about this? Also, if I am not mistaken OneCall is not a UR company. I think they arrange transportation and translation services.
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Re: UR approval, denied by Onecall (California)

Postby doublecrush on Thu Feb 11, 2016 10:37 am

Yes to all questions. Thank you.

New question. With an approved UR, can I change providers within the MPN?
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Re: UR approval, denied by Onecall (California)

Postby Manila on Thu Feb 11, 2016 3:00 pm

Yes, you can change to a different doctor in the MPN. The treatment approval is for any same specialty doctor in the MPN.
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Re: UR approval, denied by Onecall (California)

Postby doublecrush on Thu Feb 11, 2016 3:17 pm

Thank you Manila.
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