Question:
What do i need to do for an appeal thats getting an external review?

I've been turned down twice by Great West, so this last appeal gets sent out to be reviewed externally. My attorny is sending out the letter, I called my ins company to see if i needed to send anything with it, but they said they would send all my info for the appeal. Does that sound right? can i trust them to send ALL my documents? After all, they dont want to pay for it anyway! What should i do?    — [Deactivated Member] (posted on January 1, 2003)

January 1, 2003
Do you know specifically what they have in your file - in other words are you comfortable that everything that can work for your case is there? Did you see the stuff the surgeon sent? I know I was very disappointed in what the surgeon sent and ultimatly it meant insurance has asked for more info. Have you given them a detailed diet history with lbs lost? Do they know about all of your diseases not just the few co-morbids that your surgeon maybe chose to mention? Is your insurance company close that you could ask for an appointment to review what they will send to the independent reviewer? If not, then I would definitely go to the surgeon's office and review what they sent. Only you can truly present the big picture of your history. Even if they are bent out-of-shape that you want to review what was sent - tough. You are entitled! This is most likely your last appeal avenue so it is important that you know what is being sent to the external reviewer. If you check things out and you do not feel it fully conveys everything then sit down a write your story in your words and make sure insurance send it along. If the reviewer has any questions about anything you write it can be verified or discussed further. Pull out all of the stops! Good Luck!
   — zoedogcbr