Question:
INS.CO. LOST MY APPEAL PACKET WHAT WOULD U DO???
I need HELP big time guys. My ins. co. lost my expedited appeal request and in speaking with them today I was told that it may be possible to file my appeal over the phone ( first request for approval was denied due to medical necessity)so this time I sent my own appeal letter along with support letters from my pcp, weightloss surgeon, chiropractor and my ob/gyn. not to mention pictures and an emergency room release paper stating that I was seen for back pain and given a script for vicodin and phenergen. I don't see how it is to my benefit to give all that info over the phone. My pcp says that I don't have enough documentation in my chart to prove medical necessity but that he believes that I do meet the requirements. ( Iknow I should have complained more to him). But he wrote a GREAT support letter... so I don't know if its good idea to ask him to appeal it over the phone for me if its permitted. Oh by the way I did send my appeal by certified mail so I do have a receipt that they received it. The thought of trying to prove medical necessity over the phone SCARES ME TO NO END... how do they even know that I'll be telling them the truth..... ANY AND ALL SUGGESTIONS ARE WELCOME AND DEFINATELY APPRECIATED — tracy W. (posted on November 23, 2004)
November 23, 2004
I am far from the best authority to answer.but many people here have taught
me many good lessons.
I know hindsight is always 20/20. You should have had duplicates of
EVERYTHING! In lieu of that..start rebuilding. Surely you did the letter
on the computer and it can be reprinted. I would thing your PCP did as
well and is only a matter of copying what is in your file. It's pretty
negligent of a doc not to have a hard copy of all correspondence as well as
digital data of this correspondence. Of course copies of all the medical
evidence. From your PCP your OBGYN the bariatric surgeon the ER and anyone
else who may have treated you, right down to where you got scripts filled.
Retrace your steps.mentally and in the paper trail. Get it all together
again and be certain to make additional copies this time if you haven't
already.
I would not do the appeal over the phone as you are not in person with
them...more opportunity to dismiss you(just my personal opinion). Make it
in person or in writing and hold them accountable for losing the papaers
that you have valid proof that they took delivery and when.
Do it the same this time.
I'm sure others will offer more suggestions but this is all that comes to
mind right now.
Best wishes......and GO GET EM!!!!!!
Marsha
— Wings In Waiting
November 23, 2004
The insurance company is a lying scumsucking dog. With the number of
appeals that have been "lost" by the insurance companies, even
when they have been FedExed, UPSed, sent certified mail, etc., and the
patient has PROOF that they received it, they just shrug and say OH WELL,
we don't know where it is, so it's on YOU, the patient, to resubmit. I'll
be there is a MOUNTAIN of paper in each and every insurance office of
appeals they "lost" -- just to delay and frustrate you into (they
hope) going away and giving up. Don't let them win! Get copies, if
necessary, but first you demand to speak to the HEAD of the appeals
department and tell them that THEY have that goddamned appeal, you have
PROOF it was received, and it's on them to find the damned thing and act on
it appropriately, or you WIN BY DEFAULT. You won't but it should get some
action, and let them know you aren't a gullible idiot.
— [Deactivated Member]
November 23, 2004
Hi. This "losing" of patient information and other items seems
to be a common delaying tactic, and in spite of reqistered letters, my
office has this problem all the time. REMEMBER: health care providers and
their associates (i.e. insurance companies) must protect your information
under FEDERAL LAW (HIPPA) I've found that reminding them of this sometimes
gets an immediate response. We send in photos for plastic surgery, and I
often ask: if you don't have them, then where is this VERY personal and
confidential information on my patient? Its unfortunate that patients and
physicians have to go through this.
— DrL
November 23, 2004
I hope you 'xeroxed' everything before you sent it to them the first time.
If so, just re-xerox and the send it 'next day air'. This is a good
example of when you send anything to the insurance company to have 'return
receipt' and signature confirmation from the post office. Then if they
'loose it' ... its their fault, and basically they would be in 'fault' when
the waiting period ended. But thats another story. I would do next day
air; not phone. Unless you can talk to the medical nurse directly; now
I've done that and that sometimes is 'very' effective.
— star .
November 23, 2004
Hey,
I sent my appeal letter in certified mail as well. When I got the signature
card back, I immediately called the insurance company and they said that
they hadn't received it. I said "No worry I have everything in
duplicate and I would hand deliver it to them this time." Not 5
minutes later they called me back to let me know they had received it. So
Good luck, but I would recommend that you keep a copy of
"Everything". I am still waiting a reply from them.
— dixie24fan
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