Timely filing of appeal or grievance with PPO per Texas state health insurance law?
Free Insurance Quote Comparison
Secured with SHA-256 Encryption
UPDATED: Jul 18, 2010
It’s all about you. We want to help you make the right legal decisions.
We strive to help you make confident insurance and legal decisions. Finding trusted and reliable insurance quotes and legal advice should be easy. This doesn’t influence our content. Our opinions are our own.
Editorial Guidelines: We are a free online resource for anyone interested in learning more about legal topics and insurance. Our goal is to be an objective, third-party resource for everything legal and insurance related. We update our site regularly, and all content is reviewed by experts.
Insurance Question from Fort Worth, TX
Asked on 07/18/2010
Timely filing of appeal or grievance with PPO per Texas state health insurance law? I was denied a procedure by my PPO. My physician claims they have had approval from my PPO to perform this procedure on other patients and has no insight on what makes my request different to my PPO.The procedure was FDA approved for the treatment of uterine fibroids in 2004. My PPO categorizes this procedure -MRI-guided focused Ultrasound- as "experimental." Specific to Texas state insurance law how long do I have to file appeals/grievences? I understand under ERISA I may have longer than my PPO says and as of last week I've missed the second appeal deadline stated by my PPO.
Answer given on July 19, 2010
Here is a helpful link for you.
You can fill out a griveance online. As far as how long do you have to file a greivance, I have no idea. If you’ve already missed the deadline offered by the PPO contract, you may well be out of luck.
Here’s some info on TIC for pre-authorization of claims:
About two thirds of the way down the page on the above link it discusses what an insurer can/can’t do, etc. As far as a deadline for filing a complaint, it sounds like you’ve already mussed the contractual deadline.
As far as ERISA goes, I’m not sure they can do much for you. But there is a free consultation/contact link on this website, located here:
I’d start there and see what they say.
IMPORTANT NOTICE: These answers are for general information purposes only and are provided by the person answering and FreeAdvice.com AS IS. It has not necessarily been reviewed by the management staff of FreeAdvice.com nor is it binding any insurance agent, broker, or other insurance professional or any attorney or insurance company. Insurance laws, regulations and practices vary from state to state and insurance policies and practices differ from company to company, by type of policy, by state and locality and by type of insurance. Tiny variations in the facts, policy language or a detail not set forth in a question often can change the outcome or a professional's conclusion. Although FreeAdvice.com has confirmed that the answer(s) was/were provided for the account of an experienced insurance professional, that professional may not be licensed in the state referred to in the question, and may not be experienced or up to date in the subject area. Unlike the answers provided here, upon which you should NOT rely, for personal advice you can rely upon we suggest you consult a licensed insurance professional in your area or retain a licensed attorney listed on AttorneyPages.com to represent you.