Question:
I spoke to the appeal manager last Thursday, will she be the one

to review my case or will she just get the appeal process started? The clinic never sent my info for my appeal in so I called and spoke to her and she asked me to send her my appeal packet so she could get the appeal started. She sounded like she would be the one to review it but I was wondering?    — Lynda T. (posted on October 8, 2001)

October 9, 2001
If the appeal manager is a registered nurse, she'll probably review the clinical documentation and the contractual guidelines and make a decision. If she doesn't have a medical background, she she'll review the contractual issues and forward the clinical info to a nurse or physicial reviewer for a medical determination. The final determination will come in a letter over her sigature.
   — [Anonymous]

October 11, 2001
In my case, I had an RN who was my case manager but not the person to evaluate my medical necessity. After my first denial I asked for an expediated appeal with a doctor who specialized in weight loss mangement. It was approved within 24 hours by the second doctor. Don't be affraid to ask specific questions and ask the case manager what the third step will be, then the fourth and so on. Let her know you will not be going away. Best of luck!!!
   — Erin H.