Proving that I am Dedicated?

[Tammy Thornton]

@DianaCox & @Larra ,

Dr. Sudan's office informed me that my insurance company has said they do not believe that I am dedicated to the DS lifestyle and want PROOF of it. We are at a loss. I provided them with a year's worth of food diaries, passed all the psych & nut requirements (and even had to make the psych do an extra test because it was mentioned in their requirements), I have jumped through every hoop.

The ONLY thing that I can think of that may be holding me back is the fact that when I was put on U-500 insulin and my body began to regulate itself again, I gained weight. However, I have lost since then...not all but about 20 lbs. My endo and Sudan put this gain in their notes as directly medication related.

Do either of you have any other ideas of what they could be wanting? They don't give specifics at all. Thank you so much!!!! Tammy

 

[southernlady]

Not either one but I know they will want a copy of your Evidence of Coverage (health policy)...your copy not the generic one for the insurance company. If you don't have a copy, ask the HR rep at your company or go to the member section of your health insurance company and download a copy.
They will also need copies of all correspondence.

Good luck with your battle...those two are excellent at Tilting at Windmills!

 

[DianaCox]

Exsqueeze me?? Your INSURANCE company is substituting their judgment of your fitness for surgery for your treating physician's judgment??

Sudan should immediately request a peer-to-peer review with the insurance company's medical director.

 

[Larra]

If there some language in your EOC that requires proof of "dedication"? Are there specifics of what constritutes proof? If not, they are violating their own policy, which is a contract. I think the peer-to-peer is a good idea, but if for some reason that doesn't work or they refuse to do it, you can certainly appeal this. It sounds bogus.

 

[Munchkin]

^^^Do what they said! Insurance companies are not doctors and have no business judging your dedication.

 

[Tammy Thornton]

Thank you all for the help! I am just seeing this, my apologies for not replying before! I was approved yesterday after spending most of the day with my attorney prepping for my hearing on Monday! I think it was bogus, they were hoping that I'd give up. Not ME! LOL Wendy at Sudan's office told me that she sent in more proof of their "Center of Excellence" certification (Medicaid knows who is certified, it was their rule to begin with!!!) and I was approved! Seriously? But the bottom line is that I am going to get the surgery AND from Sudan! YIPPPEEEEEE!!!!!!!!!!!!!!!!

 

[Larra]

Tammy, I think you got it right - they were hoping you would give up and just disappear. I'm so glad you didn't, but I bet other people do, and then the insurance company saves some money, at least for this quarter, which is really all they care about. After all, if you need some expensive care a few years down the line because you didn't get your surgery now, you may have a different insurer and they are off the hook.
congratulations on your approval and keep us posted as you move forward. And I hope you will be an example for others that insurance company crap like this can be overcome.

 

[Spiky Bugger]

@Larra said "crap."

 

[robs477]

Larra said "crap."

 

[robs477]

@Tammy Thornton, Very Happy for you, congratulations!

 

[JackieOnLine]

yay for getting approved, Tammy!

Larra said "crap."

 

[Larra]

@Spiky Bugger I'm so sorry! I was under duress, or stress, or ...or...oh dear, I can't think of any other excuses. I apologize sincerely to you and anyone else I may have offended, but especially you as I know how delicate your sensibilities are.

 

[newanatomy]

Congrats on your approval! May the rest of your journey be smooth!

 

[Spiky Bugger]

@Spiky Bugger I'm so sorry! I was under duress, or stress, or ...or...oh dear, I can't think of any other excuses. I apologize sincerely to you and anyone else I may have offended, but especially you as I know how delicate your sensibilities are.

I managed to refrain from getting the vapors. I was just documenting for whatever the current equivalent of Ripley's Believe It or Not! might be.

Later, I will alert the media.

 

[Larra]

I will send some smelling salts your way. I would personally wave them under your nose if I were closer.