Business ProfileforMedata, Inc.

Medata, Inc. just denied the routine replacement of a pacemaker/defibrillator for a 61 year old disabled women who suffered a catastrophic brain injury from her first heart sudden cardiac arrest. ********* compensation has previously authorized and paid for the original device and subsequent replacement as her injury was determined to be work related. It seems clear that this utilization review company's goal (hired by *********) is to delay, deny and obfuscate the utilization review process so that people in dire need of services give up on trying to obtain them. Many of their listed phone numbers for their company DO NOT WORK. Her doctor has called twice for a peer to peer utilization call but there was no one at the company to answer the phone. The doctor left TWO messages and HAS RECEIVED NO REPLY. The claims adjuster from Sedgewick called and was placed in a phone cue with 24 other phone calls before her on hold. It is disgraceful that this woman's life is actually in jeopardy as the battery life on her device is running out and no one can be reached to appeal this egregious decision. This BBB review is a rather desperate attempt to help this elderly, disabled woman get the care she is *********** as an injured probation officer through ********* compensation.

Medata takes this complaint very seriously and addressed the issue promptly. Medata received a request on January 12, **** regarding this medical request however it had inadequate supporting documentation. As such, our vendor contacted the medical provider by telephone regarding the documentation needed but the provider did not respond. As such, a non-certification decision for the treatment was issued thereafter on January 16, ****. On January 24, ****, the insurance companys adjuster contacted Medata by email and an appeal was processed. Based on the appeal, on January 26, **** a decision to approve the treatment was issued on an expedited basis after a call with the treating provider confirmed the required information. We are aware that there were issues with our phone system and we taken actions to resolve this issue.