Stricture saga continues.....& I hate HMO's

Linda,

I agree with Juilicatts. A few years ago I needed back surgery and was passed from doctor to doctor while waiting for ins. auth. well by the time I got to the nero-doc. about 7 months later he had told me he was putting in a emergency auth. Seen the nero-doc on Thursday morning and Monday morning I was in surgery for my back. It can be done you just need to find the right doc who will fight for you.

K~

Linda, did you ever ask your Dr about botox for the stricture? The lady that lives next door had the same problem and her Dr sent her to UCSF and they used botox and it has worked wonders. I will keep my fingers crossed that you aren't denied but if you are srart writing a letter explaining why you need this as well as have your Dr do the same.
(((((HUGS))))
and Good Luck
JOY

Linda,

I am so sorry to hear about all of this, you have been through so much.  I am adding you to my prayer list and send warm hugs your way too.

One thing I would recommend, call your insurance and see who you can see that specializes in this area.  They might just allow you to go out of network in this instance if you and your Dr's office documents things.

Please don't give up, it will get better.

Hugs,
Barb

If your IPA will not approve the referral to the specialist your GI doc wants you to go to, they will have to refer you someone in their network who can help you. I think your IPA usually has 5-7 days to deny or approve the referral. Call them a couple of days after the referral is submitted. If it's denied, appeal to your insurance, and ask them for an expedited appeal.  If your case doesn't qualify for an expedited appeal, then your insurance has 30 days to give you an answer. If you don't get an answer on the 31st day or if you get denied contact the DMHC and see if they can help you. Don't let this dishearten you. Your IPA has to provide you with someone who can fix the problems you are having  If they don't have anyone in their network, then they have to refer you out-of-network. Best of luck

Thank you so much for information.  I will definately take your advise.

Linda

Putting aside the well intended advice above, what are your labs like to date? Your're far enough out assess your status. Any deficiencies seen there would likely also assist you with a needed appeal all the way through an IMR if needed. Demonstrable deficiencies at this stage might not only jeopardize your current health and well being, but could very well preclude any needed invasive procedures you might need in the future.

Much easier to get this in check now then waiting till it's too late sometimes taking months or even years to correct same.

Just saying,

Rockne

Thanks Rockne,

Good advise.  I do currently have a couple of deficiencies.  I will definately give that information in my appeal letter.  I am actually reading my isurance EOC on appeals this morning.


Thanks
Linda

Dear Linda,

I was so hoping that this time would work for you.  All I can say is that you know we are all behind you and maybe some of these suggestions posted will work for you!

*hugs*

Naomi