DMHC IMR Decisions Report

Diana S.

Well-Known Member
Joined
Nov 21, 2016
Messages
80
Location
Georgetown, CA
If you're crazy like me, you hate waiting for your answer. Even though I've submitted my complaint to the DMHC and they've accepted it for IMR (YAY!), and all I have to do is be patient (BOO), I still check my mail twice a day and scour the internets for statistics and stories to make me feel better about my chances.

Now I'm not seeing a lot of people posting (here or on other sites) about their IMR experiences. I see a lot of "I'm going to," and "good luck!!" but no follow up, which is a bummer because I get all emotionally invested in their stories.

But anyway, through my obsessive scouring I found this little gem. It's a 10 Year report about the DMHC and the IMR process from inception to 2010. There's a section about bariatric surgery on page 15 starting in the second column, and makes me feel pretty darn good about getting the news back I so desperately want to hear from this IMR Decision.

Also shows a graph at the top of page 16 that by 2010, 38 IMRs were submitted for bariatric-related reasons and of those 38 cases, only 6 upheld the insurance's denial. SIX. I like those odds, yessir. It's also a lot of good information about what's theoretically happening with my case in IMR-land, how the process works, the good this process has done for people like us, the changes they're effecting with wonky insurance rules, etc. It was a good read for many reasons.
 

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  • PDF IndependentMedicalReviewHistory.pdf
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"IMRs involving bariatric surgery grew rapidly early in the decade, from 27 in 2001 to 91 in 2003. During the same time, IMR results overturning health plan denials grew from 22 to 52. After 2003, though, the number of IMRs for bariatric surgery declined and has since remained steady at roughly 40 per year since 2005."

One of those 2003 IMRs was ME! And quite a few of the DS-related ones since 2005 or so have had @Larra and me involved :)
 

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