(Dumb) Quarterly Ins. Board Meeting*&PIC*

Jamie, this is more Diana's territory than mine, but I would think your insurance would have a policy regarding time limits for responses to grievances, and that this would be in writing somewhere. For example, most insurers say they have 30 days to review your grievance or appeal and provide you with a response. It isn't unusual for them to run a few days over, but at least that gives people a reasonable time frame.
      Check your policy and see what it says about how long they have to give you an answer on an appeal, or ask Diana for further advice.

Larra

Larra,

There is more wording in my reply to Diana regading my insurance.  I plan on calling the secondary insurance on my lunch to make sure that this is where my appeal is going (see my reply to Diana below)



Thank you for the awsome words of wisdom!!!!
-Jamie

Call them and ask them when you can expect an answer, as you are waiting for MEDICALLY NECESSARY SURGERY, and you are getting sicker by the day.  Ask for a copy of any documentation that relates to time periods for a response - they cannot put you off indefinitely, and it should not be necessary to wait for a quarterly meeting for review of a claim.  This is not a claim for reimbursement, which could theoretically wait - it is a claim for approval for DOING the surgery in the first place.

Diana,

Here is a brief explanation from my booklet, YES, I will call in the next hour and find out if this is where my appeal is going.  If you want more of the body of one of the headings, please let me know!!!!!

There are several sections in my secondary insurance Summary Plan Description and Plan Document. 
  Notice Of Denial 

  Board of Trustees’ Procedure for Hearings 
 
Right to Hearing  
  
Scheduling of Appeal
The trustees will review a properly filed appeal at the next regularly scheduled quarterly meeting of the Board, or the authorized committee, unless the request for review is received by the Trustees within 30 days preceding the date of such meeting. In such case, the appeal will be reviewed no later than the date of the second quarterly  meeting following the Trustees’ receipt of the notice of appeal, unless there are special cir****tances requiring further extension of time, in which case a benefit determination will be rendered not later than the third quarterly meeting of the board, or authorized committee, following the Trustees’ receipt of the notice of appeal. If such an extension of time for review is required because of special cir****tances, such as a request for a hearing on the appeal, then prior to the commencement of the extension, the Plan will notify the claimant in writing of the extension, describe the special cir****tances and the date as of which the benefit determination will be made.  


The Hearing Procedure   Decision After Appeal Hearing  

Review of trustees’ Determination

Again, THANK YOU!!!!!!
-Jamie