!!!!! I Won My Appeal !!!!

hi esa--

its not the surgery that they are denying. they are denying that I need to have a gynecological surgeon do it. they gave me the names of four infertility specialists! I am allowed to go out of network and they are supposed to do 70% but they then claim the charges are way over reasonable and customary. I am going to have a humongous bill if I don't figure something out. i think you are right that everything needs to be in writing. my doctor wrote a letter--- he is my pcp and they still denied it. would you be willing to e mail me the letter of appeal that you wrote? nancie

Nancie,
I would love to, however, I don't have it. It's in my appeal file at insurance and I don't have it. I am allowed to get all my info in my appeal file at no charge, and I am going to do that, just so I have it. Basically, it was a form from my insurance and it was a page with lines for me to write. On it it said that I am to write why I am appealing, include any events, dr.'s, and any information that I would feel would explain or help my situation. So I did. In a quick overview, I wrote about when I first had problems, to trying medicines, to having less invasive surgery, to waiting it out, to going back to gyn again, to learning that my uterus and fibroid has grown, to incontinence problems. Then I proceeded to tell how I had surgery denied, 3 times, and how I thought it was a complete injustice to have decided that this was the best option for me only to have insurance decide what is best for my body. I stressed the quality of life issue. Anyone with horrible bleeding and clots and pain knows how your quality of life diminishes. I also said that I will go to whatever higher sources necessary to advocate for myself.

My personal letter to insurance that went in my file was much longer. With that, I wrote down every complaint, ache and pain associated with the surgery...from enlarged uterus, fibroid, incontinence, pelvic fullness, frequent urination, cramps, not being able to have sex with my husband, having to deny my kids because of my medical issues. I explained one time where I literally flooded my pants in public and had to go to a bathroom and take off my clothes, clean up the floor, toilet, me etc., and put back on my blood soaked clothes and walk out with "any amount of dignity I could muster without looking like I saw a ghost". Then I took each one and wrote about it. I had 5 pages.

I hope this has helped a little. Keep me posted.

Erica

erica--- this is giving me good ideas. can I e mail you the letter that I am writing to my congressman? thanks-n

I don't mind at all. I don't know if I can help, but I can definitely read it. I have the gift of gab and writing has been something for me that has come easily. Go ahead, I'll be up for a while. I think you can do it through this site.