3rd Level DEnial

[Nichole]

They denied again.

My doctor presented alot of great information. He provided a article regarding 15 years post-op informaiton. Which they were very suprised to see. He provided incredible informaiton to the board regarding both the pro's and con's of this surgery especially for a patient in my age bracket. He presented everything perfectly. I was given also the opportunity to tell the board the "HELL" that I have been going thru during all of this. But......again....their answer is no.

This time their denial was based on the fact that "this board can not change the medical policy for Regence". They said that if we want the "Medical Policy" changed then we will need to address that board. So basically we wasted our time even going. So I went through 3 levels of appeals with then knowing full well no matter what information I provided, my doctor provided or anyone else....the answer would still be no. So the next step is the Independ Review Organization. This will be my last attempt to change their decision. However....this level is probablly the one that will be most in my favor. The "Independant Review Organizaion" has the autority to over rule the "Medical Policy" on a case by case basis. So my doctor and the rep from DePuy are going to get an organized presentation together to present to the "IRO". This will be my last appeal. If the answer is still no, then I will be having a fusion unfortunately.

So that is the latest update.

[Justin]

Nichole,

I am sorry to hear of your denial. I can empathize with you--Dr. Bertagnoli was retained as my professional on my side when I went to my appeal in person. Needless to say, they had their mind made up before I walked in the door as well.

I know how much time, money and effort goes into each level of appeal----I am sorry----I considered going to prison after I received my denial phone call (they called "out of courtesy" and stated that a letter would follow--blah).

Insurance companies are evil!

Keep your head up,

Justin

[DWebster]

Nichole, I am sorry about them turning you down agian, this just seems so insane and unlogical!!! I just don't understand what there motives are? are they getting kick back from the people that sell the fusion inplants? ogd I wish there was someway to stop this insanity!! I wish you the best of luck on the next appeal.
Please hang in there, don't give up there has to be way.

Dave

[JL]

Nichole, We have been thinking of you all day. The effort of appeal must be like the biggest preparation battle possible. I remember going before a property tax review board once upon a time. What a slamereo. Never a peep of light. Minds were made up the night before. But only a few dollars were on the table. I don't know what to say. You are ahead of me by several months. You have to focus on your pain management, that is something maybe you can gain some control over. What do you need to buy more time to out last them? I also am thinking I will end up with fusion before long. Can you tell we had lousy weather all day? The first level of claims training for insurance persons is denial. So is the second and third. After that they begin to think we are going to take it personally and they will make an offer.

[Jim M2]

Nichole,
Sorry to hear you have to take it to another level. I hope your pain levels are behaving.

Jim

[bmills]

Nichole, that stinks and I'm sorry to hear it. I'm getting ready for my level 2 appeal.

I'm starting to think some of the insurance companies need to loose some lawsuits for this pain and suffering. Hopefully your 3rd level works out.

I can't count the hours I've spent gathering information and making phone calls dealing with the insurance stuff. I know what you're going through.

Brady

[biffnoble]

the amazing thing is due to a paucity of aircraft carriers in germany even with the euro stomping the $ surgery with a top doc like dr. b. is 1/2 or less than the equivelant op in the USA. a bargain!

[Justin]

Biff,

It is true that Dr. B is a bargain, however 30k is still 30k any way you look at it (especially when you are 23 at time of surgery ).

Good luck on your last appeal Nichole--it is good to see your doc is hanging with you through each step of the way.

Justin

[biffnoble]

being sick and in pain is no bargain no matter how you "slice" it! agreed!!!!!!!!!!!! I know!! good luck nichole!!!!

[NCFUSED]

Sorry to hear about your denial, I just received the letter yesterday from my second denial from UHC. What a joke, once again, a doctor never even looked at the information I sent. Poor spelling, even mispelled "artificial disc"....

Well my 3rd appeal is up tp my Benefits Committee at work, if they refuse, then it looks like fusion here also....

Best of Luck!