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Insurance Hell All insurance-related matters are here: Medicare, worker's compensation, appeals, denials, insights, wins, losses. PRICING is here too. Note: This forum has posts from 2006 forward. Older ones are in the Big File.


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  #1  
Old 01-15-2007, 08:45 PM
Nairek Nairek is offline
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Join Date: Apr 2005
Posts: 148
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Well, I sent out my second level appeal on Saturday. All 147 pages of it in a nice little binder with tabs to separate individual sections for them. I'm such a stinker. With any luck, it will reach Albany by tomorrow. Hopefully I'll have a reversal of my healthcare provider's decision within 30 days. All I know is I'm progessively getting worse & it's going to be a looooong wait.
__________________
----Karin----
Disc Bulge C4/C5, Disc Degeneration T11/T12, Bi-Lateral tears L5/S1, Diagnosed w/ Lumbar Disc Derangement w/ Radiculopaphy. Treatment: IDET, Percutaneous Discectomy, SI Joint Injection, Facet Block. All failed. Empire BC/BS Denied Coverage for ADR-lost all of my appeals. MVP also denied coverage.

ALIF/PLIF Fusion 1/20/09
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  #2  
Old 01-16-2007, 05:46 AM
Kim_Dean\'sWife Kim_Dean\'sWife is offline
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Join Date: Oct 2006
Posts: 108
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I'll be keeping my fingers crossed for you and your appeal! (I'll be appealing for my husband when we get denied soon, too.)
Stay positive and keep up the fight!

Kim
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Wife of Dean, age 32.
Injured 12/05- snow shoveling.
Herniated Discs & DDD at
L4/5 & L5/S1.
-Chiropractic treatment
-3 Failed injections
-Orthopedic Massage
Prodisc Surgery on 2/22/07 Dr. Yue
Yale New Haven Hospital, CT
L4/L5 & L5/S1
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  #3  
Old 01-16-2007, 08:11 PM
Nairek Nairek is offline
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Join Date: Apr 2005
Posts: 148
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Hi Kim,
Thanks for the positive thoughts. My appeal arrived in Albany today so hopefully I will have a positive decision in 30 days. This whole appeals process is a real pain in the back, literally. I'm a very stubborn person; this is something that I won't give up on easily. At 32, I shouldn't feel like 82......

I wish you & Dean all the best on your appeal. I noticed that the state of Connecticut has a Department of Insurance that you can appeal to if your healthcare provider denies coverage. Look into that to see if it's an option for you.
I can't remember where I got this link from, but it's a starting point. http://www.kff.org/consumerguide/7350.cfm
__________________
----Karin----
Disc Bulge C4/C5, Disc Degeneration T11/T12, Bi-Lateral tears L5/S1, Diagnosed w/ Lumbar Disc Derangement w/ Radiculopaphy. Treatment: IDET, Percutaneous Discectomy, SI Joint Injection, Facet Block. All failed. Empire BC/BS Denied Coverage for ADR-lost all of my appeals. MVP also denied coverage.

ALIF/PLIF Fusion 1/20/09
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  #4  
Old 01-17-2007, 05:57 AM
Kim_Dean\'sWife Kim_Dean\'sWife is offline
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Join Date: Oct 2006
Posts: 108
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Thank you so much for the link! I wasn't aware of that! I too am stubborn enough to follow all the way through with my husband's appeal process. And he, too, is tired of feeling 82 at age 32!

When we read about your nice little binder with tabs separating individual sections, we laughed and my husband said that that sounds exactly like something I would do. We wish you the best and we'll be looking to see how you make out!
Kim
__________________
Wife of Dean, age 32.
Injured 12/05- snow shoveling.
Herniated Discs & DDD at
L4/5 & L5/S1.
-Chiropractic treatment
-3 Failed injections
-Orthopedic Massage
Prodisc Surgery on 2/22/07 Dr. Yue
Yale New Haven Hospital, CT
L4/L5 & L5/S1
Back
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  #5  
Old 01-17-2007, 08:50 PM
Nairek Nairek is offline
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Join Date: Apr 2005
Posts: 148
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Yeah, I tend to go a bit overboard when it comes to details. I'm studying to become a paralegal. (I already have my certificate, just working on my Associates Degree now.) So I have quite a bit of experience when it comes to legal research. When I told my OS about the content of my appeal, he told me that if I could get a decision in my favor, he would pay me to write appeals for his other patients. I laughed. I wanted to say "how about doing my surgery pro bono?" I don't think he'd go for it though.
__________________
----Karin----
Disc Bulge C4/C5, Disc Degeneration T11/T12, Bi-Lateral tears L5/S1, Diagnosed w/ Lumbar Disc Derangement w/ Radiculopaphy. Treatment: IDET, Percutaneous Discectomy, SI Joint Injection, Facet Block. All failed. Empire BC/BS Denied Coverage for ADR-lost all of my appeals. MVP also denied coverage.

ALIF/PLIF Fusion 1/20/09
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