Q: Looking to see if this is something even worth pursuing but I would like justice.
Managed care company . Needed specific radiation treatment recommended by neurosurgeon. Denied by insurance company, appealed. Reviewed by a "pediatrician" who agreed to not provide the treatment . Dragged their feet on authorizing my care. Reported them to the Department of Managed Healthcare in the state of California.
Excerpt of complaint findings: "Based on the information submitted the department find that LA care was not in compliance with it's obligation under applicable California healthcare law with regard to timely providing you access to a specialist. The department has noted this incident for the purpose of determining a pattern of non-compliance by LA care and possible enforcement action pursuant to California Law. ...... The Departments review of the complaint does not prevent you from pursuing other legal options that may be available including the contacting of an attorney, sincerely, XXXX Senior counsel Department of Managed Health care.
A: Maybe. Whether it is worth looking at in detail depends on your injuries as a result of the delay or declination in coverage. Did the condition worsen? Did your recovery suffer? Do you have permanent injuries that you would not have had if the radiation had been approved in a timely manner?
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