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

2008:			December - November - October - September - August - July - June - May - April - March - February - January
	December
		• 30 -	BCBSM 100504-Nonpanel services; non-emergency hospital physician services
		• 30 -	BCBSM 100155-Medical necessity; continuous blood glucose monitor
		• 30 -	PRIORITY HEALTH 100382-Medical necessity; testosterone therapy
		• 29 -	UNITED HEALTHCARE 100384-Covered benefit; facility charges
		• 22 -	PHPMM TPA 100842-Out-of-network services
		• 22 -	BCBSM 100310-Nonpanel provider; hospital care
		• 22 -	BCBSM 90162-Pre-existing condition limitation
		• 22 -	BCBSM 100386-Excluded benefit; orthodontic care
		• 22 -	PRIORITY HEALTH 100892-Out-of-network services; laser discectomy
		• 22 -	BCBSM 90570-Orthotic device; provider restriction
		• 22 -	BCN 101342-Covered benefit; shoe orthotics
		• 02 -	BCN 100833-Wellness program eligibility
		• 02 -	BCBSM 100420-Eye surgery, nonparticipating provider
		• 02 -	AMERITAS 100692-Dental necessity; dental crowns
	November
		• 24 -	BCBSM 100169-Covered benefits; nonparticipating facility; cosmetic surgery
		• 24 -	PHPMM TPA 100842-Covered benefit; out-of-network surgery
		• 20 -	GOLDEN RULE 92791-Medical necessity; back surgery
		• 20 -	BCN 92539-Covered benefit; dental extractions
		• 20 -	BCBSM 92896-Durable medical equipment; out-of-network provider
		• 20 -	BCBSM 92962-Covered benefit; sanctions for using nonpanel provider
		• 20 -	BCBSM 91566-Medical necessity; residential substance abuse treatment
		• 20 -	BCBSM 86596-Covered benefit; home modifications
		• 20 -	BCBSM 91021-Medical necessity; continuous passive motion device
		• 20 -	BCBSM 91565-Covered benefit; aquatic therapy
		• 20 -	BCBSM 91341-Nonqualified provider; coronary CT scan
		• 12 -	MIDWEST SECURITY 100307-Medical necessity; spine surgery
		• 12 -	HAP 100436-Covered benefit; panniculectomy
		• 12 -	BCBSM 92964-Experimental device; nerve stimulator
	October
		• 28 -	PRIORITY HEALTH 100502-Heart surgery, nonparticipating provider
		• 28 -	BCN 100123-Policy exclusion; speech therapy,
		• 28 -	BCBSM 100040-Policy exclusion; emergency room care
		• 28 -	BCBSM 92787-Applied behavioral analysis therapy
		• 28 -	PRIORITY HEALTH 92560-Spinal surgery, nonparticipating provider
		• 21 -	BCBSM 92651-Air ambulance service
		• 14 -	BCN 100070-Wellness program eligibility
		• 14 -	PRIORITY HEALTH 92727-Alopecia, medical necessity
		• 14 -	BCBSM 91124-Experimental/investigational treatment; neurobiofeedback therapy
		• 14 -	TIME 91345-Pre-existing condition; gastrointestinal condition
		• 14 -	HAP 92710-Covered benefit; applied behavioral analysis therapy
		• 14 -	BCBSM 92550-Covered benefit; out-of-network surgery
		• 14 -	BCBSM 91993-Covered benefit; psychotherapy
		• 06 -	BCBSM 92027-Experimental/investigational treatment; spinal surgery
		• 01 -	BCBSM 91148-Deductible; nonpanel provider
		• 01 -	BCBSM 91102-Prescription drug coverage; formulary exception
	September
		• 09 -	BCBSM 90629-Covered benefit; mental health provider
		• 09 -	BCBSM 91123-Out-of-network services; referral for cancer treatment
		• 09 -	PHPMM 90379-Out-of-network services; breast reconstruction surgery
		• 09 -	MAGELLAN 90377-Covered benefit; residential psychiatric care
		• 09 -	BCBSM 89803-Covered benefit; application of deductible and copayments
		• 09 -	BCBSM 89079-Out-of-network services; dental surgery
		• 09 -	BCBSM 88559-Covered benefit; midwife services
		• 09 -	BCBSM 91088-Excluded benefit; genetic test
		• 09 -	BCBSM 91059-Covered benefit; dental care
		• 09 -	BCN 91045-Durable medical equipment; wheelchair
		• 09 -	BCN 91020-Out-of-network services; dermatology treatment
		• 09 -	BCBSM 90990-Covered benefit; dental extractions
		• 09 -	BCBSM 90947-Experimental/investigation treatment; disk replacement surgery
		• 09 -	BCBSM 90946-Out-of-network surgery; facility charge
		• 09 -	BCBSM 90913-Covered benefit; mental health provider
		• 09 -	BCN 90824-Covered benefit; wellness program eligibility
		• 09 -	UNITED HEALTHCARE-90709 Medical necessity; radiology services
		• 09 -	BCBSM 89526-Out-of-network services; burn mask
		• 09 -	BCN 92543-Covered benefit; occupational therapy
		• 09 -	BCBSM 91190-Covered benefit; durable medical equipment
		• 09 -	HUMANA 92546-Deductible; laboratory services
		• 09 -	BCN 91980-Covered benefit; hearing aid
		• 09 -	AMER COMMUNITY 91401-Pre-existing condition; cataracts
		• 09 -	BCBSM 91229-Covered benefit; dental care
		• 09 -	TIME 91189-Medical necessity; chiropractic care
		• 09 -	LIBERTY UNION 90976-Out-of-network services; out-of-country injury
		• 09 -	BCN 90481-Covered benefit; wellness program eligibility
		• 09 -	BCN 91590-Covered benefit; chiropractic care
		• 09 -	HAP 90609-Covered benefit; glucose monitor
	August
		• 18 -	BCBSM 90608-Covered benefits; application of deductible
		• 18 -	PHPMM 90584-Covered benefits; dental crowns
		• 18 -	BCBSM 90527-Experimental/investigational treatment; artificial disk replacement
		• 18 -	AETNA 90456-Experimental/investigational services; homocysteine test
		• 18 -	BCBSM 90392-Covered benefits; CT scan
		• 18 -	USHL 90799-Out-of-network services; durable medical equipment
		• 18 -	BCBSM 90381-Experimental/investigational treatment; applied behavioral analysis therapy
		• 18 -	BCN 90646-Out-of-network services; brachytherapy
		• 18 -	BCBSM 90627-Covered benefits; prenatal care
		• 18 -	BCBSM 88987-Medical necessity; emergency room treatment
		• 18 -	MIDWEST SECURITY 90374-Covered benefits; alternative medicine
		• 18 -	MIDWEST SECURITY 90376-Covered benefits; alternative medicine
		• 18 -	BCN 90734-Covered benefits; wellness program participation
		• 14 -	METLIFE 90567-Medical necessity; tooth build up
		• 14 -	BCBSM 90419-Experimental/investigational treatment; surface electromyography
		• 14 -	BCBSM 90105-Experimental/investigational treatment; sublingual antigen drops
		• 14 -	ALLIANCE HEALTH 90334-Out-of-network services; physician visits
		• 14 -	BCBSM 89847-Covered benefits; diabetic nutritional counseling
		• 14 -	BCBSM 89880-Covered benefits; applied behavioral analysis therapy
		• 13 -	PHPMM 90535-Medical necessity; orthognathic surgery
		• 13 -	BCBSM 90715-Out-of-network services; surgery
		• 12 -	AMERICAN COMM 90532-Out of network services; pathology
		• 12 -	BCN 90583-Healthy living program participation
	July
		• 31 -	BCBSM 88034 - Deductible amount
		• 25 -	Midwest Security 87602 - Pre-existing condition exclusion
		• 25 -	BCBSM 89904 - Durable medical equipment
		• 25 -	Liberty Union 89672 - Medical necessity; chiropractic care
		• 25 -	BCBSM 90063 - Covered benefits; occupational therapy
		• 25 -	BCN 89314 - Enhanced benefit program; qualification
		• 24 -	Midwest Security 90067 - Medical necessity; chiropractic care
		• 24 -	Liberty Union 89673 - Medical necessity; chiropractic care
		• 24 -	PHPMM 89883- Physical therapy, maximum number of sessions
		• 24 -	Priority Health 89801- Out-of-network providers; ambulance; radiology
		• 24 -	Priority Health 89920- Deductible; laboratory services
		• 24 -	Priority Health 89628 - Experimental treatment; disk replacement
		• 03 -	Midwest Security 89740 - Out-of-network services; out-of-state surgery
		• 03 -	BCBSM 89579 - Out-of-nework DME; CPAP machine
		• 03 -	BCBSM 89456 - Nonparticipating provider; hair prosthesis
		• 03 -	BCBSM 89453 - Experimental treatment; disk replacement
		• 03 -	PHPMM 89578 - Covered benefits; artificial insemination
		• 03 -	PHPMM 89382 - Out-of-network services
		• 03 -	Midwest Security 88708 - Covered benefits; diagnostic and screening tests
		• 03 -	Liberty Union 89097 - Experimental treatment; IV gamma globulin
		• 03 -	BCBSM 89271 - Experimental treatment; meniscal allograft transplant
		• 03 -	BCBSM 89384 - Out-of-network services; sex reassignment
		• 03 -	PHPMM 89621 - Out-of-network services; level of benefits
	June
		• 23 -	USHL 89177 - DME; lift chair
		• 23 -	BCBSM 89339 - Amount paid; nonparticipating surgeon
		• 23 -	HAP 89317 - Exclusion; dietary food
		• 23 -	BCN 89284 - Exclusion; dental implants
		• 23 -	Connecticut General 89099 - Experimental care; botulinum toxin injections
		• 23 -	BCMI 89038 - Exclusion; pre-existing condition
		• 23 -	United Healthcare 88144 - Exclusion; pre-existing condition
		• 23 -	BCBSM 88991 - Experimental treatment; disk arthroplasty
		• 23 -	BCN 88669 - Exclusion; treatment of chronic conditions
		• 04 -	BCBSM 89171 - Exclusion; dental implants
		• 04 -	BCBSM 89096 - Experimental treatment; light box
	May
		• 27 -	Aetna 87477 - Experimental treatment; biofeedback
		• 27 -	PHPMM 88365 - Out-of-network services; chiropractic care
		• 27 -	Priority Health 88561 - Covered benefits; vision therapy
		• 27 -	BCN 89098 - Surgery; deductible, copayment, and coinsurance
		• 20 -	BCBSM 88841 - Medical necessity; excision of excess skin
		• 20 -	Golden Rule 89187 - Rehabilitation benefits
		• 13 -	Time 89007 - Durable medical equipment; custom-made knee brace
		• 12 -	World 88678 - Cosmetic surgery; septorhinoplasty
		• 12 -	Time 88635 - Experimental treatment; long-term antibiotic therapy
		• 12 -	American Community 88572 - Emergency care
		• 12 -	Humana 88437 - Covered benefits; cranial molding orthosis
		• 12 -	BCBSM 88426 - Residential mental health treatment
		• 12 -	PHPMM 88391 - Out-of-network services
		• 12 -	BCBSM 88364 - Medical necessity; private duty nurse services
		• 12 -	BCN 88272 - Medical necessity; speech therapy
		• 12 -	PHPMM 88276 - Orthognathic surgery
		• 12 -	USHL 87866 - Covered benefits; ambulance service, breast pump
		• 12 -	Golden Rule 86968 - Covered benefits; waiting period
		• 12 -	BCBSM 88707 - Out-of-network services; MRI
		• 12 -	BCBSM 85748 - Covered benefits; infusion therapy
		• 12 -	BCBSM 88779 - Colonoscopy; pre-surgical consultation
		• 12 -	BCBSM 88843 - Covered benefits; dental care
		• 12 -	BCBSM 88852 - Covered benefits; dental surgery
		• 12 -	BCN 88939 - Copayment; surgery
		• 12 -	BCN 89011 - Out-of-network services; back surgery
		• 12 -	BCBSM 88720 - Out-of-network services; disk surgery
	April
		• 30 -	BCBSM 88520 - Occupational and speech therapy; nonparticipating provider
		• 29 -	BCBSM 87156 - Drug benefits; coordination of benefits
		• 29 -	BCBSM 88428 - Durable medical equipment; amount paid
		• 29 -	Humana 88430 - Ambulance service; amount paid
		• 29 -	BCBSM 88617 - Participating provider; emergency surgery
		• 25 -	Aetna 87617 - Inpatient mental health and substance abuse care
		• 22 -	BCBSM 88300 - Experimental treatment; sleep apnea
		• 21 -	PHPSM 88188 - Prescription drug copayment
		• 21 -	BCBSM 87962 - Experimental services; LP-PLA2 test
		• 21 -	BCBSM 88140 - Experimental services; computerized dynamic posturography
		• 21 -	BCBSM 87642 - Covered benefits; eligible mental health provider
		• 21 -	Paramount 87587 - Out-of-network services; reproductive endocrinology
		• 21 -	BCBSM 88194 - Physical therapy requirements
		• 21 -	BCBSM 88195 - Participating provider; emergency treatment
		• 21 -	Mega Health 88148 - Experimental services; foot care
		• 21 -	Midwest Security 88172 - Experimental services; erectile dysfunction drugs
		• 21 -	HealthPlus 87687 - Covered benefits; air ambulance service
		• 21 -	BCBSM 87256 - Covered benefits; inpatient mental health care
		• 21 -	BCN 87907 - Manipulation therapy; prior approval
		• 21 -	Care Choices 86750 - Covered benefits; occupation and physical therapy
	March
		• 28 -	BCBSM 87245 - Dental coverage; waiting period
		• 28 -	Time 87569 - Policy exclusion; growth hormone
		• 26 -	Humana 88006 - Nonparticipating facility; eye surgery
		• 26 -	HUMANA 88019 - Policy exclusion; dental surgery
		• 26 -	BCBSM 88141 - Nonparticipating provider physician services
		• 26 -	BCBSM 88171 - Prescription drug; generic or brand name
		• 24 -	BCBSM 87583 - Policy exclusion; colonoscopy
		• 24 -	PHPMM 87717 - Policy exclusion; smoking cessation program
		• 24 -	BCBSM 87763 - Covered amount; nonparticipating provider
		• 24 -	USHL 87773 - Policy exclusions, emergency care/dental treatment
		• 24 -	BCBSM 87989 - Nonparticipating provider; air ambulance
		• 24 -	BCBSM 87990 - Nonparticipating provider; hearing aids
		• 24 -	Aetna 87409 - Medical necessity; Doppler artery study
		• 24 -	BCBSM 85079 - Out-of-network dental care
		• 24 -	HAP 87329 - Experimental treatment; prostate cancer
		• 10 -	BCBSM 87449 - Out-of-network surgery
		• 06 -	Aetna 87380 - Out-of-network services; rheumatology
		• 05 -	PHPMM 87392 - Covered benefits; orthodontics and dental orthotics
		• 05 -	PRIORITY HEALTH 87248 - Durable medical equipment; weight suit
		• 05 -	Mega Life 87282 - Out-of-network surgery
		• 05 -	BCBSM 87394 - Application of deductibles and copayments
		• 05 -	BCN 87334 - Drug coverage; formulary exception
		• 03 -	BCBSM 86803 - Experimental surgery; disk replacement
		• 03 -	American Medical 87306 - Covered benefits; dental services
		• 03 -	PHPMM 87406 - Out-of-network benefits
	February
		• 28 -	BCBSM 87336 - Excluded benefit; orthodontic care
		• 28 -	PHPMM 87326 - Deductible; physical therapy
		• 28 -	Aetna 87308 - Policy exclusion, gastric bypass surgery
		• 28 -	IBA 87307 - Outpatient mental health services
		• 28 -	BCN 87171 - Excluded benefit; oral surgery
		• 26 -	BCBSM 87071 - Speech and physical therapy
		• 26 -	Aetna 87152 - Out-of-network services
		• 26 -	BCBSM 87070 - Experimental treatment; knee surgery
		• 19 -	Great Lakes 86386 - Bariatric surgery
		• 18 -	PHPMM 87135 - Drug coverage, experimental and medical necessity
		• 15 -	USHL 87204 - Emergency care; out-of-network services
		• 15 -	PHPMM 87105 - Deductible; laboratory tests
		• 15 -	USHL 82426 - Deductible; out-of-network services
		• 08 -	BCBSM 87139 - Excluded benefit; abortion
		• 08 -	BCBSM 87127 - Out-of-network emergency surgery
		• 08 -	BCN 86412 - Nonformulary drug
		• 08 -	IBA 86821 - Cosmetic procedure
		• 08 -	Magellan 86112 - Out-of-network mental health benefits
		• 08 -	BCBSM 86556 - Out-of-network surgery
		• 08 -	BCBSM 87102 - Pre-existing condition limitation
		• 08 -	BCN 87062 - Experimental surgery; disk replacement
		• 08 -	BCBSM 86985 - Out-of-network services
		• 08 -	MERS 86887 - Out-of-network surgery
		• 08 -	Paramount 86883 - Emergency services; medical necessity
		• 01 -	Humana 86824 - Pre-existing condition limitation
		• 01 -	HAP 86877 - Prescription drug copay
		• 01 -	BCBSM 86885 - Covered benefit; immunization
		• 01 -	Assurity Life 86640 - Experimental treatment; cancer trial
		• 01 -	BCBSM 86594 - Covered benefit; hearing aid
	January
		• 28 -	Midwest Security 86822 - Exclusion, infertility treatment
		• 23 -	BCBSM 86833 - Out-of-network surgery
		• 23 -	Aetna 86735 - Covered benefit, dental surgery
		• 23 -	American Community 86652 - Experimental device, stimulator and full back conductive garment
		• 23 -	BCBSM 86557 - Medical necessity, molecular diagnostic test
		• 23 -	BCBSM 86369 - Experimental treatment, prolotherapy
		• 23 -	Union Security 86318 - Coverage issue, dental benefits
		• 23 -	PHPMM 86552 - Covered benefit, speech therapy
		• 23 -	Chesapeake 85964 - Exclusion, congenital conditions
		• 23 -	BCBSM 84588 - Autism treatment
		• 14 -	BCBSM 86690 - Amount paid - outpatient surgery
		• 14 -	BCBSM 86682 - Amount paid - Outpatient Surgery
		• 14 -	BCN 86564 - Midwife care and home birth
		• 14 -	BCBSM 86257 - Inpatient substance abuse treatment
		• 14 -	Care Choice 85592 - Prior approval for mental health care
		• 10 -	HAP 86834 - Respiratory virus injection for infant
		• 07 -	Priority Health 85024 - Sleep Apnea Surgery


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