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More archives for:
PRIRA Cases: 2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2003 | 2002

2012:			May - April - March - February - January
	May
		• 16 -	BCBSM 125480; Covered Benefit; Substance Abuse Treatment
		• 16 -	Celtic 125724; Pre-Existing Condition
		• 16 -	United 126798; Medical Tests; Non-Network Provider
		• 16 -	BCBSM 126097; Out-of-Network Services; Dental Appliances
		• 16 -	BCBSM 123577; Non-Participating Provider; Eating Disorder
		• 16 -	Priority Health 125993; Emergency Room Deductible
		• 16 -	BCBSM 126276; Out-of-Network Provider; Mental Health Services
		• 16 -	Magellan 126735; Experimental/Investigative; ABA Therapy
		• 16 -	US Health & Life 126273; Out-of-Network Services; Laboratory Tests
		• 10 -	BCBSM 126731; Medical Necessity, Prescription Drug
		• 10 -	BCBSM 126207; Medical Necessity, Prescription Drug
		• 10 -	BCBSM 125761; Medical Necessity, Skilled Nursing Care
		• 10 -	Federated Mutual 126609; Medical Necessity, Laboratory & X-Ray Services
		• 10 -	BCBSM 126684; Prescription Drug Coverage
		• 10 -	BCBSM 125802; Medical Necessity, Inpatient Mental Health Care
		• 10 -	United Healthcare; 126556; Medical Necessity, Mental Health Care
		• 10 -	BCBSM 124934; Surgery, Investigational
	April
		• 30 -	US Health & Life 126554-126555; Non-Network Services
		• 30 -	Priority Health 126103; Copayment, Surgery
		• 30 -	BCBSM 125738; Medical Necessity, Prescription Drugs
		• 30 -	BCN 126398; Wellness Program Eligibility
		• 30 -	BCN 126371; Pre-Existing Condition
		• 30 -	BCBSM 126206; Waiting Period
		• 30 -	Time 125763; Covered Benefit, Behavioral Health Services
		• 30 -	BCBSM 125769; Application of Deductible
		• 30 -	BCBSM 126394; Prescription Drug Coverage
		• 30 -	BCBSM 126407; Prescription Drug Coverage
		• 30 -	US Health & Life 126554-126555; Non-Network Services
		• 30 -	BCBSM 124957; Covered Benefit, Physician Office Visit
		• 27 -	BCBSM 126277; Deductible, Nonparticipating Provider
		• 27 -	Humana 125811; Exclusion, Pre-existing Condition
		• 26 -	Guardian 126105; Medical Necessity, Dental Treatment
		• 20 -	Priority Health 125996; Prescription Drug Coverage
		• 20 -	BCBSM 126098; Amount Paid, Nonparticipating Provider
		• 20 -	BCN 126209; Wellness Program Eligibility
		• 20 -	BCBSM 125997; Substance Abuse Treatment, Nonparticipating Provider
		• 20 -	BCBSM 126151; Contraceptive Coverage
		• 20 -	BCBSM 125732; Deductible, Amount Paid
		• 13 -	United Healthcare 124973; Substance Abuse Care, Eligibility
		• 13 -	BCBSM 125812; Emergency Treatment, Eligibility
		• 13 -	BCBSM 124994; Experimental-Investigational Treatment
		• 13 -	BCBSM 125612; Medical Necessity, Pain Management Therapy
		• 13 -	Connecticut General 125155; Mental Health Treatment, Level of Care
		• 13 -	Humana 125273; Experimental-Investigational Treatment
		• 10 -	Guardian 125156; Medical Necessity; Crown Build-Up
		• 10 -	BCBSM 125541; Drug Coverage; Off-Label Use
		• 10 -	BCBSM 124820; Approved Amount, Medical Device
		• 10 -	BCBSM 125245; Ineligible Provider
		• 10 -	BCN 125224; Covered Benefit; Healthy Living
		• 10 -	BCBSM 125577; Covered Benefit; Vision Therapy
		• 10 -	BCBSM 123408; Exclusion; Prescription Drug Coverage
		• 10 -	BCBSM 125404; Surgery; Experimental/Investigational
		• 10 -	BCBSM 125195; Out-of-Network Facility
		• 10 -	BCN 125789; Policy Exclusion; Dental Care
		• 10 -	BCBSM 124818; Out-of-Network Surgery
		• 10 -	BCBSM 125139; Investigational Treatment; Transcranial Magnetic Stimulation
		• 09 -	BCBSM 125098; Pre-Existing Conditions
		• 09 -	BCBSM 125301; Prescription Drug Coverage
		• 09 -	BCBSM 125199; Medical Necessity; Inpatient Substance Abuse Care
		• 03 -	Guardian 125490, Medical Necessity; Dental Care
	March
		• 27 -	BCBSM 123212, Application of Deductibles; Pre-existing Condition
		• 26 -	BCBSM 124286, Medical Necessity; Extracorporeal Photopheresis
		• 26 -	Humana 124370, Experimental or Investigational Device
		• 26 -	BCBSM 124944, Medical Necessity; Prescription Drug
		• 23 -	BCBSM 124936, Out-of-Network Surgery
		• 23 -	BCBSM 123672, Unauthorized Service, MRI
		• 23 -	BCBSM 124955, Policy Exclusion; Dental Care
		• 23 -	BCN 125097, Covered Benefit; Durable Medical Equipment
		• 23 -	BCBSM 124932, Durable Medical Equipment Rental
		• 22 -	Guardain 124369, Medical Necessity; Dental Crowns
		• 22 -	Automated Benefit Services 124368, Medical Necessity; Dental Veneer
		• 19 -	BCBSM 124706, Covered Benefits; Diagnostic Tests
		• 19 -	BCBSM 124711, Medical Necessity; Emergency Room Care
		• 19 -	BCN 124844, Wellness Program Participation
		• 19 -	BCBSM 124689, Emergency Room Care; Nonparticipating Provider
		• 19 -	BCBSM 124849, Application of Deductible
		• 19 -	BCBSM 124956, Nonpanel Services; Application of Deductible
		• 13 -	BCBSM 123578, Application of Deductible
		• 13 -	BCBSM 124935, Deductibles; Nonpanel Providers
		• 08 -	Principal Life 122738, Medical Necessity; Inpatient Hospital Care
		• 08 -	BCBSM 124269, Waiting Period; Pre-existing Condition
		• 08 -	PHP 124947, Experimental Procedure; Varicose Veins
		• 08 -	BCBSM 124336, Policy Limits; Speech Therapy
		• 08 -	BCBSM 123892, Substance Abuse Treatment; Level of Care
		• 07 -	BCBSM 124453, Durable Medical Equipment; Adjustable Bed
		• 07 -	BCBSM 124456, Medical Necessity; Emergency Room Care
		• 06 -	BCBSM 124633, Policy Exclusion; Diagnostic Test
		• 06 -	US Health 124377, Bariatric Surgery; Covered Criteria
		• 06 -	BCN 124382, Covered Benefit; HPV Vaccination for Males
		• 06 -	BCBSM 124351, Policy Exclusion; Mental Health Care
		• 06 -	BCBSM 124458, Preventative Care Benefits; Waiting Period
		• 06 -	BCBSM 124943, Covered Benefits; Dental Care
		• 06 -	BCBSM 124350, Covered Benefits; Private Hospital Room
	February
		• 28 -	Time 121617, Covered Benefit; Varicose Vein Exclusion
		• 28 -	PHP INSURANCE 124187, Unproven Treatment; Prescription Drug
		• 28 -	BCBSM 124291, Out-of-Network; Emergency Services
		• 28 -	PHP 124540, Drug Coverage; Exclusion
		• 28 -	BCBSM 125229, Medical Necessity; Inpatient Care; Eating Disorder
		• 28 -	BCBSM 122315, Copayment; Prescription Drugs
		• 28 -	BCBSM 124016, Covered Benefit; Oral Surgery
		• 28 -	BCBSM 124016, Covered Benefit; Oral Surgery
		• 28 -	HAP 124362, Policy Limitation; Varicose Vein Treatment
		• 28 -	BCBSM 123924, Experimental Treatment; Transcranial Magnetic Stimulation
		• 28 -	Guardian 124293, Medical Necessity; Dental Procedure
		• 28 -	McLaren Health Plan 124532, Experimental Care, Autism Treatment
		• 22 -	BCBSM 123760, Medical Necessity; Prescription Drug
		• 22 -	BCBSM 123971, Covered Benefit; Speech Therapist Services
		• 22 -	BCBSM 123752, Covered Benefit; Contraception
		• 22 -	Humana 123840,Out-of-Network Services; Prosthetic Eye
		• 22 -	BCBSM 123582, Medical Necessity; Flexor Patch
		• 17 -	Humana 123472, Dental Care; Waiting Period
		• 16 -	Humana 123472, Dental Care; Waiting Period
		• 15 -	BCBSM 123627, Preventive Care; Laboratory Tests
		• 15 -	BCBSM 124306, Policy Limits; Substance Abuse Treatment
		• 15 -	Guardian 123998, Covered Benefit; Crown Buildup
		• 14 -	BCBSM 123708, Covered Benefit; Implanted Contraception Medication
		• 14 -	BCBSM 123705, Covered Benefit; Durable Medical Equipment; Bed
		• 14 -	Humana 123485, Dental Service; Exclusion
		• 14 -	BCBSM 118975, Covered Benefit; ABA Therapy for Autism
		• 14 -	BCBSM 123959, Dental Coverage, Exclusion
		• 13 -	BCBSM 123376, Investigational Treatment; Outpatient Cardiac Telemetry
		• 13 -	BCBSM 122419, Medical Necessity; Emergency Room Treatment
		• 13 -	BCBSM 123521, Inpatient Mental Health
		• 13 -	BCBSM 123855, Medical Necessity; Prescription Drug Coverage
		• 10 -	BCBSM 124018, Exclusion; Dental Care
		• 08 -	BCBSM 122512, Experimental-Investigational Treatment; Prosthetic, Device
		• 08 -	BCBSM 123318, Covered Benefits; Office Visit
		• 08 -	Wayne State University 123214, Out-of-Network Services; Application of Deductible and Coinsurance
		• 08 -	BCBSM 123256, Pre-Existing Condition Limitation
		• 08 -	Humana 123412, Deductible; Lab Tests
		• 08 -	BCBSM 123831, Non-Participating Provider; Amount Paid
		• 08 -	BCBSM 122785, Deductible; Diagnostic Services
		• 08 -	BCBSM 123006, Medical Necessity; Reconstructive Surgery
		• 08 -	Priority Health 123832, Deductible; Non-network Provider
		• 08 -	Humana 122898, Out of Network Services
		• 08 -	BCN 123570, Eligibility; Wellness Program
		• 08 -	BCBSM 123605, Medical Necessity; Prescription Drug
		• 08 -	BCBSM 123580, Investigational Procedure; Surgery
		• 06 -	BCN 125300, Experimental-Investigational; Surgical Procedure
		• 06 -	BCBSM 123375, Experimental Device; Neuromuscular Stimulator
		• 06 -	BCBSM 123995, Midwife Services
		• 06 -	BCN Service Company 123764, Application of Deductible
		• 06 -	BCBSM 123717, Preventive Care; Colonoscopy
		• 02 -	BCBSM 123711, Covered Benefit, Occupational Therapy
		• 01 -	BCBSM 123483, Substance Abuse Treatment; Inpatient
		• 01 -	BCBSM 121586, Office Visit Limit
		• 01 -	BCBSM 122839, Laboratory Services; Nonpanel Provider
		• 01 -	BCBSM 123740, Medical Necessity; Emergency Room Treatment
		• 01 -	BCBSM 122838, Preventative Care; Nutritional Counseling
		• 01 -	BCN 123543, Eligibility; Wellness Program
		• 01 -	BCN 123544, Policy Limits; Occupational Therapy
		• 01 -	Priority Health 123523; Deductibles and Copayments; Carryover
		• 01 -	BCBSM 123429, Application of Co-Payment and Deductible
	January
		• 31 -	BCBSM 123326, Out-of-Network Services; Surgery
		• 31 -	BCBSM 123035, Medical Necessity; Outpatient Cardiac Telemetry Monitor
		• 31 -	Guardian 123091, Dental Necessity; Core Build-Up
		• 31 -	BCBSM 123029, Medical Necessity; Prescription Drugs


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