I Just Had the WORST morning ever...

Hey guys, I just had my 2nd Appeal hearing for approval (actually, it was to overturn an exemption) this morning and it was just horrible. Not so much the insurance people... they were very nice and considerate and listened very attentively. However, my lawyer, who we were suppose to call to conference call him in, could not be gotten a hold of. We called over and over and they graciously agreed to delay the start of the hearing to wait for him. And still, nothing. Finally I decided to not make them wait anymore and had to start. I had to present my case ALL ALONE and I had no idea what I should say. It was just one of those moments where you want to scream like a child, throw a fit and run out of the room. It was just bad. Amazingly, I held it together and did pretty well - just shared my personal journey and how I came to the decision to have surgery. They asked lots of questions and were very nice. But still, I feel like if my attorney had been there I would have a better chance. I'm just exhausted and weepy and mad. I'm suppose to find out today what their decision is - everyone I know has been praying that somewhere in their hearts they will decide to say yes. Just had to vent, I'm kind of a mess right now.

I will keep you in my thoughts and hope you get a positive outcome. Sorry about the lawyer. Take care Erin

Thanks Erin, I appreciate the good thoughts. I certainly need them today!

Hi, PJ: I'm sorry to hear this. As I mentioned to you in an earlier private email exchange, he didn't show up at my second level appeal meeting, either. I kept asking him why he didn't show, and I never did get an answer. Among others here at OH who groused about him last summer was a woman who posted publicly that he didn't show up for her phone conference, either. He immediately posted back that he had tried to call in numerous times from wherever he was vacationing, but that he couldn't get through or didn't have the correct number, or some other such nonsense. I was hoping he'd gotten his act together since last summer, but it sounds like business as usual, unfortunately. Do you have external appeal rights, or is this the last step? I'm not familiar with how the appeals process works with regard to exclusions. Hugs, Kix

Thanks Kix - I was thinking about you while I was sitting in there. I had even confirmed with him yesterday, made sure I had the correct number and everything. Here's the kicker - I call him after it is done, I get right through, and he said he has been trying to call and he keeps getting VM. So, I rush back in and my rep at Blue Cross said they had tested the phone and it worked fine. I turns out he never got our original messages and was trying to call her, not the conference room. I finally made that clear to him and he told me he would take care of it - haven't heard back. I'm not holding my breath. Just more excuses. I have no other recourse except a lawsuit after this appeal. I've always said I would be willing to do that but I didn't really want to. I just refuse to go into debt for something the insurance company SHOULD be paying for. The funny thing is I trust the insurance company more than my attorney - how sad is that! (I know you know who I am talking about but I am holding off on naming him. When I do actually name him it will be in a formal complaint to the bar association as well as on here.)

Just got the call - they said no. Will only pay $1500. I think I'm gonna go home, crawl into bed and cry myself to sleep.

Oh, no! That seriously blows. This can't be the end of it. I wonder if our state Division of Insurance might be of any help? (Probably not, but it's worth pursuing). Is your company policy self-funded? If not, then I believe the State of Colorado has a law that says you have the right to request an external review. If I hadn't won at external review, my HMO never would have covered my surgery (they said it wasn't medically necessary because my BMI was too high! Can you imagine?) The external reviewer basically said PTUI! and ruled in my favor. My HMO denied me at both internal reviews; once I won at external review, they have been extremely helpful in preparing me for surgery this August. If all else fails, does Dr. Chae have any kind of self-pay plan? Many surgeons offer a discounted package plan for self-pay patients. I've heard excellent things about Dr. Chae (my endocrinologist highly praises him) -- see what they can do for you if you end up having to self-pay. Not only that, a pox on the attorney, whom we now know is basically useless. I wonder how many other people have been burned by his subpar work? Grr, Kix

I like that icon, fits how I am feeling right now. Our company isn't self funded but I am going to double check on the external review. Anthem told me this was my last option because it was an exemption, but I'm not so sure I believe them. I'm going to try to find out more tomorrow. My parents have insisted they want to pay for it but I don't feel comfortable with that - they are retired and I don't want to put that retirement in jeopardy. As for self pay, I just might check on that. I initially said no but if I can get a discount than I just might go that route. I also have a couple of other options I'm working on... however it just seems so overwhelming. And yeah, a major pox on him - I haven't talked to him, not sure if I want to. He left me out to dry and it feels pretty crappy.

I am sorry your motning went so bad. I will keep you in my prayers and hope everything goes fine. Hopefully tomorrow will be better. Keep your chin up. love marie

PJ, I'm so sorry you're having to go through all of this. And that really sucks that your lawyer couldn't even show up. He sounds like a class A FLAKE!!! I wish you the best and i know this will work out for you somehow. I know that doesn't help to hear people say that , but I really believe it. Take care. jacie