Question:
Should I be excited?

Hello. I was just curious about something. I recieved a phone call from a lady at my insurance company yesterday & she told me that my file "has been sent to review". I told her that I already knew that it was under review - & she said that it had actually gone to the one review board and that they had sent it to a physician for review. I thought that this had sounded somewhat promising & wanted to see if anyone agreed. I have a written exclusion in my policy and if they were going to deny it outright due to that then they would have already done it - right? I asked the lady if that meant that the doctor would have the "final say-so" (other then appeal if necessary of course) and she said "yes", and I asked if that also meant that the dr would base it on medical necessity - & she also said "yes". I have asked others, & they've just told me not to get excited that this lady is just a "low paid call taker without the ability to interpret a policy or make a decision". Any ideas??    — amandalianne (posted on December 6, 2002)

December 6, 2002
I don't know it is kind of an unusual situation. All medical necessities are determined by a doctor or an R.N., for insurance companies, so that isn't too unusual. The strange part is that the insurance company called you in the first place. Mine didn't and when I called them they didn't even know my Dr. had submitted a request. The request are not put in your file until they are approved or denied, so when I called they knew nothing about it. I would think Guarded optimism is the way to go. It is a good sign that they called you but that doestn't mean that your out of the woods yet. Good Luck though!!!
   — dkinson

December 6, 2002
My case went for review by the MEDICAL DIRECTOR for BCBS. I got approved. Best of luck on your journey!
   — k r.