[Nichole]

Hi everyone,

It was brought to my attention that I should let you all know what I have gone through so far. I am sure most of you read my earlier post about my insurance denying me for the ADR. I am now in the process of my second level appeal. This is what I have been working on the last couple of weeks.

I wrote a letter to my insurance company requesting an "in person" appeal and faxed that over to them yesterday. In the meantime I have also been doing alot of reaserch on what information I can bring to the appeal. Who I can bring etc. My doctor and I are working very closely together on this appeal. He will be attending the "in person" appeal as well as a representative from the manufacturer of the Charite. Which is really exciting.

I have contacted my local insurance commissioners office and they have put me in contact with SHEBA (Statewide Health Insurance Benefits Advisors). I spoke with a gentleman today from that office and he told me the following information. If I can get in writing a letter from Medicare stating that this is covered benefit this will be another plus in my corner for the appeal. I will need to bring that documentation to the appeal and state that "Medicare is seeing this surgery as reasonable and customary, therefore it is a customary treatment for my diagnosis". Usually when Medicare covers a procedure it's not long before the other insurance companies follow suit. I am hoping that the Artificial Disc follows as the others have. I am also trying to get as much information as possible to bring to this appeal. I would like to talk to as many people as I can who have had success on their appeal and find out what verbage was used, what codes and etc. to bring to my appeal.

I was helped by Richard in some questions to ask Regence and my local insurace commissioner prior to my "in person" appeal. They are as follows: Who will be present from the insurance, What are their roles, What kinds of questions will be asked, and Who can I bring and what can I bring?

I just spoke with my insurance company and the following people will be present for my appeal:
Registerd Nurse w/panel of representatives who are as follows: 1 company representative, 1 appeal counselor, 1 administrative representative who is a member service specalist with contracting, 1 enrollment and claims specialist, and one medical director. Phew, thats alot of people from their side. A little overwhelmed by that. Yikes, I am feeling a little scared now about this appeal.

Anyway, I will continue to post my process as I go. Thank you again to all of you for your support, suggestions and prayers as I walk this journey.

Nichole