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

LADIES...........

I AM SO HAPPY RIGHT NOW. I CAN'T BELIEVE THIS IS HAPPENING. I WON MY APPEAL !!!!!!!!!!!!!!!!

I JUST FOUND OUT 15 MIN. AGO. TODAY WAS THE 15TH DAY AND INSURANCE WAS TO MAKE THEIR DECISION BY THIS DAY. WELL, THE OUTSIDE FIRM OF DOCTORS IN OREGON WHERE THEY SENT MY FILE, APPEAL AND LETTERS DECIDED AGAINST MY INSURANCE AND FELT THAT I WAS DEFINITELY IN NEED OF THE SURGERY. SO INSURANCE HAD TO APPROVE IT. I WILL BE GETTING MY OFFICIAL LETTER THIS WEEK SOMETIME.

I called the surgery scheduling girl at the gyn's office and was like, "Renee...we won !!!!". She said the insurance should fax an authorization # to her and if she doesn't get it by Fri. she'll call and get it. If I get my letter in the meantime, I am to call her and tell her and tentatively, although not written in stone, she is holding an April 7th spot for me. She needs the authorization # to book it officially. I said waiting isn't anything now...I went through all this, I can wait a little longer. Besides, my husband has to go away to Chicago for 12 days for business and he won't be home until Apr. 2, so I didn't want to do it before and then be left alone. So, I'll wait a little longer.


I made the member services person at my insurance repeat to me 3 TIMES that it said APPROVED.


I want to thank all of you for your kind words, prayers, and well wishes. You definitely helped me make it through this. I couldn't have done it without you. I really felt like it was not going to happen. I truly didn't think it was going to be approved.

Well, I am just one blubbering, crying fool right now. I even broke down on the phone with the member services lady I was talking to. She started laughing and said "if you're happy, I'm happy". I said "you have no idea.........."

Thank you all again, and I will let you know when I have a definite date, but I'm shooting for April 7th.

Erica

Erica,
I am so happy for you. I cannot even emagine going through what you have. I will keep you in my prayers that you get the date you want and especially that you have a speedy, uneventful recovery. God bless and take care.

Connie

wooooohooooo !!!!!!!!!!!!!!!!!!!!!!!!!!!!!


Doing a happy dance for you. I'm glad your going to get the medical care you need. Good luck

Tralee

What wonderful news!! So happy to hear this

Erica, congratulations!!!

Erica, I'm so happy that your appeal was successful. It is a real shame that the insurance companies have so much control on the care that we receive. I wish you an uneventful surgery and recovery.

I'm glad you got good news and pray for your surgery and recovery to go well.

Erica, This same exact thing happened to me and I cried when the member services lady told me! I was denied twice and then finally my appeal went through!!!! Couldve had my surgery Feb 5 but I can't complain now!!!

Congrats!!!

any advice for how to win an appeal? i just was denied for which doctor and hospital i want to use. i can use any and all advice! they didn't care about my doctors medical necessity letter.

Hi,
So...we're you denied the surgery, or just which dr. and hospital you want to use? I have an HMO and must stay within their participating provider list. That wasn't a problem because my ob/gyn office is the best in our county and they participate with my insurance. And the hospital is an approved one as well. So, if it's the hospital and dr. issue, I didn't have that problem. My problem was that my insurance denied my surgery. Perhaps writing a letter will help. My dr. copied my entire file and sent it along with my appeal. I wrote a 5 page letter to the insurance company, and a letter I had to write to the appeal committee. My dr. even ordered last minute bloodwork to put the results in before they sent off my file. My file was sent out to an outside ob/gyn to get their opinion. I did call and ruffle feathers, although to me it seemed pointless at the time. I didn't think any of my phone calls would help, and don't know if they did, I think more that my file and the outside ob/gyn who decided against the insurance company was my biggest help. maybe your doctor can talk to them person to person instead of a letter. I will pray that it works out for you. If I can have my appeal won, anyone can.