okay, i can breathe again. the pity party is over my friends. thanks for hanging in there with all my whining. :)
i'm back to myself & am working on a game plan. i've been making phone calls to every doctor i've visited in the last 7 years who has blood pressure & cholesterol records in the last seven years and have been requesting records. it's hard. i've lived in dallas, denver, and now pittsburgh. i can't even remember some of their names for heaven's sake, so i had to cross austin off the list all together, LOL.
i've started writing my appeal. i'm still waiting for my official denial letter to come in the mail from the insurance company.
one of my friends in california is married to a cardio-thoracic surgeon. he's pretty cool so i emailed him and asked him for advice on how to put together a kick ass appeal. he didn't know. DAMN. what good are my connections? lol. but he said he'd tap the brain of his buddy---the director of bariatrics there at his hospital. sweet! i hope he doesn't forget. anything will help. i am not above pestering him again if i haven't heard anything by next week, lol.
for those of you who have been denied and successfully appealed-----what kinds of information did you include in your appeal? please tell me!!
and in other news....the scale is stuck. i've been hitting the gym faithfully and continuing eating right and the scale is not moving. yesterday i did a weight lifting type class for the first time (in a few years that is). it was pretty good.
SCALE??? do you hear me??? i have been good! i have been eating right and going to the gym! lower your number.
I think an appeal letter is a great idea and getting together as much paperwork as possible is also good. The insurance companies love paperwork. I ended up getting refused at the last minute and paid for my surgery. It was hugely annoying since I supposedly HAD insurance, but I don't regret it at all.
ReplyDeleteYou need to know *exactly* what you are appealing and *exactly* what info you need to provide to support your case.
ReplyDeleteMy husband & I fought & fought & fought an insurance company several years ago to get a denied surgery covered and eventually won.
DH had a benign tumor removed. Ins denied the claim saying it was a pre-existing condition that was diagnosed or treated within 6 months of him being put on my plan. While it was true that it had been diagnosed prior to him being put on(about a year before) he had sought no treatment during that time knowing it would disqualify him from coverage. We couldn't figure out why they thought he had. It took several months of badgering before they finally gave us the answer.
Turns out the clinic he was going to for monitoring/treatment of high blood pressure was coding all his visits to include checking the tumor, which they were not actually doing. The insurance co said it would take getting his "permanent medical record" changed before they would reconsider. They made it sound like that was near impossible and the provider could be accused of fraud.
DH talked to the PAC he had been seeing who had absolutely no problem making the changes and submitting the records to the insurance co. The claim was paid shortly thereafter.
Did you have insurance in Austin? If you can remember who that was I'm sure you can request claim records from them and get the names of anyone who treated you from there.
I had my own insurance troubles with my band too but that stemmed from crappy billing procedures on my clinics part.
Best of luck to you!!!
Sarah
http://nwanonymom.blogspot.com/
I agree, you definitely need to know what their exact reason for denying you is. I know your previous post said your blood pressure etc, "weren't serious enough" but I highly doubt the letter will say that. So, hopefully you will know more once you get the letter. You can try calling your insurance and asking. Keep it up, insurance can be a pain!
ReplyDelete