Name and Shame
Name and Shame

MES SOLUTIONS REVIEW

Complaint
#5YE27

This complaint was posted on NAS on 1st Feb, 2022 and is a permanent record located here: https://www.nameandshame.com/mes-solutions-5YOM3/people-not-getting-care-they-need-id5ye27 .

NameandShame Author
cbaHtb6
1st Feb, 2022

People are not getting the care they need!

I requested an independent review at the beginning of October 2021. My deductible of $1500.00 had been met. And after exhausting all attempts to get somewhere with my health insurance provider after not finding anyone in their network of doctors to properly care for my needs; I couldn’t get my doctor approved through my health insurance provider for out of network benefits. Before requesting the independent review I had been denied three times by my health insurance. They deemed my surgery was “experimental/investigational”. I requested in writing like I was informed to do so by a customer service representative as well as sent a packet of information along with the request for an external examination to the insurance headquarters of my health insurance to Los Angles, CA and Atlanta, GA like I was told to do so. Three months after the request and in this new year of 2022 when my deductible has reset; I get my denial letter from MES Solutions stating they upheld the denial decision of the insurance company that my surgery would be “investigational”! As I’m looking through their findings I see critical information not in their findings that was the sag way to everything to take place there after; that was in the information they had stated previously they received to do the review. I called MES Solutions and the representative said I had to speak with a nurse about my report. She put in a request for a nurse to call me and said one would call me shortly. Forty-eight minutes later I got a call from a blocked number and it was a nurse. The call lasted fifteen minutes before the nurse hung up on me. During the call I challenged her about the information in the report and what wasn’t put in the report that was apart of one the doctors notes they had in their information. Some of my questions she stated was out of her scope so I said why can’t I speak to a doctor then someone that can answer my questions since you guy’s are medical professionals. You’re saying the procedure is investigational; I feel like you should be able to tell me what is available and not refer me back to my insurance provider. I stated they provide insurance their not medical professionals like you guy’s so you should be able to tell me what can be done. The nurse said she answered to the best she could and that I needed to call the number at the bottom of the report if I had any other problems with the report and she could provide the number if I didn’t have it. I continued to hit her with questions and I did ask for the number but I guess I frustrated her because she hung up on me!

Looking into complaints online about MES Solutions; I come to the determination that a lot of major insurance carriers maybe not all but a lot of them use this peer review company. It makes you wonder how many thousands of Americans have lost out on much needed treatment do to the apparent “shady” practices of basically being paid off for a report that serves as a “get out of jail free” card for these multi million dollar insurance companies. And as claimants we are left to suffer without getting what the treatment we need to improve our quality of life daily! With all the advances in science and technology nowadays there is no reason why people have to suffer unnecessarily because of the insurance industry in “my personal” opinion is tightly regulated and scrutinized for their practices like they want to send you to this doctor and that doctor and still find a way to not approve coverage or it’s not apart of your explanation of benefits.

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