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More archives for:
PRIRA Cases: 2009 | 2008 | 2007 | 2003 | 2002

2007:			December - November
	December
		• 28 -	CARE CHOICES 86506 - Exclusion, orthotic device
		• 28 -	MID-WEST NAT 86445 - Exclusion, emergency room
		• 28 -	BCBSM 85560 - Coverage issue, occupational therapy
		• 28 -	BCBSM 85596 - Out-of-network, approved amount
		• 28 -	BCBSM 85642 - Out-of-network, dialysis
		• 28 -	BCBSM 85739 - Medical necessity, panniculectomy
		• 28 -	USHL 85784 - Medical necessity, cosmetic surgery
		• 28 -	BCBSM 85811 - Medical test, investigational
		• 28 -	JOHN ALDEN 86279 - Anesthesia, medical necessity
		• 28 -	BCBSM 86276 - Durable medical equipment, amount paid
		• 28 -	AETNA 86277 - Multiple surgeries, benefit limits
		• 28 -	JOHN ALDEN 86278 - Anesthesia, medical necessity
		• 28 -	MET LIFE 86391 - Exclusion, dental implants
		• 28 -	HAP 86390 - Surgery, non-network provider
		• 28 -	BCBSM 86389 - Occupational therapy, policy limitation
		• 28 -	ALLIANCE 86368 - Exclusion, orthognathic surgery
		• 28 -	HUMANA 86344 - Emergency room care, policy deductible
		• 18 -	BCBSM 85786 - Out-of-network, physician services
		• 18 -	BCBSM 84608 - Coverage issue, laboratory and diagnostic tests
		• 17 -	HUMANA 86345 - Deductible, emergency room services
		• 17 -	PHPMM 86255 - Exclusion, cosmetic surgery
		• 17 -	PHPMM 86213 - Copayment requirement, diagnostic tests
		• 17 -	M-CARE 84233 - Out-of-network, gynecological exam
		• 17 -	HUMANA 84840 - Out-of-network, surgery
		• 17 -	TIME 85525 - Medical necessity, monitored anesthesia
		• 17 -	CARE CHOICES 85783 - Medical necessity, bariatric surgery
		• 17 -	MEGA LIFE 86093 - Coverage issue, emergency room services
		• 05 -	BCBSM 85831 - Coverage issue, outpatient mental health services
		• 03 -	MEGA LIFE 85559 - Exclusion, congenital condition
		• 03 -	BCBSM 84861 - Coverage issue, physical therapy
		• 03 -	BCBSM 84199 - Medical necessity, ambulance service
	November
		• 28 -	PHPMM 84863 - Inpatient mental health care
		• 27 -	BCBSM 85852 - Surgery charges, nonparticipating provider
		• 27 -	BCBSM 84289 - Experimental service, oncotype DX test
		• 27 -	BCBSM 85641 - Coverage issue, ABA therapy for autism
		• 26 -	PHPMM 85129 - Out-of-network services, dermatitis
		• 26 -	BCBSM 85333 - Inpatient mental health care
		• 26 -	HAP 85558 - Bariatric surgery, adolescent
		• 26 -	Humana 85746 - Physical therapy, benefit limits
		• 26 -	PHPMM 85738 - Lithotripsy, experimental for fasciitis
		• 26 -	BCBSM 85428 - Medical necessity, heart scan
		• 26 -	USHL 85115 - Medical necessity, cytogenetic test
		• 26 -	BCBSM 85116 - Pre-existing condition
		• 26 -	AETNA 85737 - Experimental device, bone-anchored hearing aid
		• 14 -	BCBSM 84746 - Medical necessity, CPAP device
		• 13 -	USHL 84996 - Experimental service, hyperbaric oxygen treatment
		• 13 -	BCBSM 85132 - Inpatient mental health care
		• 13 -	BCBSM 85313 - Coverage issue, immunizations
		• 13 -	BCBSM 85305 - Experimental service, meniscal allograph transplant
		• 13 -	Humana 85529 - Coverage issue, immunizations
		• 13 -	MetLife 85640 - Coverage issue, tooth implant
		• 13 -	USHL 85027 - Coverage issue, infertility treatment
		• 13 -	PHPMM 85063 - Experimental service, lumbar diskectomy
		• 13 -	Golden Rule 77243 - Reasonable and customary charge, surgery
		• 13 -	Priority Health 85364 - Medical necessity, endoscopy
		• 13 -	Humana 85404 - Orthognathic surgery, excluded benefit
		• 08 -	BCN 85765 - Out-of-network consultation
		• 08 -	PHPMM 85830 - Out-of-network consultation
		• 06 -	AETNA 85310 - Emergency room care


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