I went to 2 walk in clinics, my primary care physician twice, who referred my to a ear nose and throat specialist in my provider network (who has been a specialist for decades), been there 2 times and on over 5 rounds of antibiotics. My specialist recommended surgery. The day before my surgery Medica would not approve my surgery and wanted a CT scan. Two days later I had a CT scan done. A report was faxed over to Medica 3 times. They finally acknowledge receiving it. Then nothing happens, I call twice a week. Then they send me a certified letter saying they want a 14 day extension and I have a right to file for an expedited appeal. I file the appeal the next day by fax. Now 3 weeks later I am calling them to check status. They say they are still processing it, I say its been a month and I need an answer, so they say its denied. I have called them numerous times, been on hold for over 30 minutes each time I call, I have talked to 10 different people that barely speak English, wasted hundreds of dollars on copays jumping through their hoops, so they can deny my surgery as I sit here sick.My opinion is that you look for another insurance company. If you look, all their addresses and phone numbers are in one suite somewhere down in south Miami where no one speaks English. In my opinion this insurance company is a scam. Do not waste your money paying their premiums every month because they stall and do not authorize your medically necessary surgeries.
4000 Ponce de Leon blvd., Suite 650 Coral Gables, Florida United States of America