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California Dept of Healthcare overturns denial of pet scans

After my Health Ins denied me PET/CT scan and again denied my appeal I requested an INDEPENDENT MEDICAL REVIEW from the California Dept of Managed Health Care. I discovered 4 precedents for PET/CT's and GIST.

COPY AND PASTE THE FOLLOWING TO PULL UP THE WEB PAGE WITH THE CASES:

http://wp.dmhc.ca.gov/imr/results.asp?optFormat=html&cboMC=Cancer&cboDiagnosis2=Other&cboDT=Diagnostic+Imaging%2C+Screening+and+Testing&cboTreatment2=PET+Scan&cboType=0&cboDetermination=Overturned+Decision+of+Health+Plan&txtDetails=GIST&cmdSearch=Search

THE FOLLOWING IS WHAT YOU WILL GET. IF YOU CLICK ON THE ID NUMBER WHEN YOU ARE ACTULLY ON THE SITE, YOU WILL GET FURTHER INFORMATION ABOUT THE CASE

Independent Medical Review Search

There were 4 records that met your search criteria (DENIAL OF PET FOR GIST DIAGNOSIS). Of the IMR cases identified, 0 of the health plans' original decisions were upheld and 4 were overturned.

Reference ID numbers begin with either MN or EI. MN is the acronym for medical necessity and applies to cases in which the disputed treatment was either delayed, denied or modified by the HMO based on medical necessity. EI is the acronym for Experimental/Investigational and applies to cases in which the disputed treatment was denied by the HMO as being experimental or investigational. The two digits following either of these acronyms indicated the calendar year in which the case was resolved by the HMO Help Center. The final group of numbers are assigned sequentially as cases are posted for your review. 


 Ref ID # Diagnosis Category Diagnosis Subcategory

EI08-7557 Cancer Other Determination Treatment Category Treatment Subcategory Overturned Decision of Health Plan Diagnostic Imaging, Screening and Testing PET Scan

Ref ID # Diagnosis Category Diagnosis Subcategory MN07-6890 Cancer Other Determination Treatment Category Treatment Subcategory Overturned Decision of Health Plan Diagnostic Imaging, Screening and Testing PET Scan

Ref ID # Diagnosis Category Diagnosis Subcategory MN07-6767 Cancer Other Determination Treatment Category Treatment Subcategory Overturned Decision of Health Plan Diagnostic Imaging, Screening and Testing PET Scan

Ref ID # Diagnosis Category Diagnosis Subcategory MN07-6247 Cancer Other Determination Treatment Category Treatment Subcategory Overturned Decision of Health Plan Diagnostic Imaging, Screening and Testing

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