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  • Comment by Stacy S. on 5/18/09 8:24 am
    Sending you the warmest of wishes your way for steady improvement day after day, And when you’re all recovered and feel good once more, May life treat you better than ever before!~ Sending you good vibes for a uneventful surgery and a speedy recovery !! ALL THE BEST
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Arkin10's Blog
Arkin10's Blog

03/09/09
posted on 3/9/09 6:36 pm
What a long weekend.  Have been so upset since last Wed when I got the denial letter and then the phone call to the insur to get details & find out I was considered "non-compliant with doctor's diet".  That really bummed me out.  Sigh.  And so it goes.  But thanks to all these wonderful folks here at OH, I got it pulled together and re-focused on the task at hand.  I got off the pity pot and pulled up my big girl panties and wrote out that appeal letter.  Two pages long....typed....single spaced.  Got some good tips from an attorney who had to appeal to get her insurance approval too.  I'm rather proud of myself as what she told me I had already zeroed in on in my Medical Policy.  Having it confirmed by a professional that I was on the right track helped lift my mood tremendously.  So now we will see.  I also took advice about calling my surgeon & asking for a copy of the letter of medical necessity.   OK, hold on.   A new twist is about to emerge.  I call the insur coordinator & ask about my missing logs from October.  She double checks my file and says, "nope, not here.  are you sure you turned them in?"

Good thing I can't reach through the telephone line.  I kept my tone light and even.  Not going to help myself by telling her off about her ineptitude and their office's disorganization.  I just sweetly said I was positive I had turned it in.  (All the while  thinking how missing data surely had to have played a part in my non-compliant with diet denial reason).  She asks why did I want it.  I explain that I had thought I could attach those missing logs along with a copy of the letter of medical necessity to the appeal letter.  She says.....are you sitting down?......."Oh, you don't have to send in those logs, they don't need them.  In fact, they don't even ask for them. "

I was stunned.  WTH?  Then why the F--- did you send them in?  THAT'S THE VERY DAMN REASON I GOT DENIED!
I swear that wonderful normal low blood pressure I had just a couple of weeks ago when I went for the EGD.....it spiked for sure.  My head began pounding so hard at that moment.  I think I went into auto pilot or something because somehow I managed to ask about the letter of medical necessity.  "Oh, you want that?  Sure, I can fax you one right now.  We keep them for whoever needs them for insurance."  (WHAT?)  I asked hadn't one been sent in with my packet?  She said no but that she'd get me one right now.  Like she was going the extra mile just for me. 

So help me Great, Glorious One Above......I'm not sure I can do more with this doctor if I don't get approval.  I can't tell if he's aware or unaware of how this was filed.  My husband is mad and thinks I should make an appt to talk to Dr. Kim but I'd rather avoid anything confrontational right now.  After all, he is going to cut on me.  LOL.  That said, I know the insurance company seems to make a sick game out of jerking their policyholders around but how can a surgeon's office be run this way?  I just can't comprehend it.  Do they have so much business that they can foul up their patient's insurance process this way and lose potential business? 

And that was just the finisher to my awful Monday.  I had already had a terribly stressful morning prior to this when my co-worker literally fell out of her chair, unconcious, and began seizuring.  Had to call 911 and the whole bit.  She thinks she had a "simple" hypoglycemic episode but I fear there is something far worse wrong as the paramedics checked her vitals & sugar level and they were all normal.  Her sugar was 120 so that ain't hypoglycemia.  I certainly pray there isn't but the vitals and what I saw just don't add up.  And she refused to go to the hospital.  We took her home & called her husband. 

What a day.  Oh well, gotta keep moving forward.  Will mail appeal letter tomorrow. 


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