Hoping, Frustrated, and Making Deals with God

[bearmom]

Yep, don't look at the whole battle picture for now, just whatever step that needs to be addressed immediately.

Eating an elephant sounds overwhelming, and the only way to do it is one bite at a time. You will win this one bite at a time and you are doing a great job so far.

You should reward yourself today. Something like a special latte, or a massage.

 

[Munchkin]

Just breathe and pick up the fight tomorrow!

 

[Clematis]

When dealing with insurance companies, perhaps it is wiser to make deals with the devil...

Sorry for the anguish. You'll win this.

 

[Spiky Bugger]

I may have told you this already, but...our daughter, who needed a size 36-J bra, opted for breast reduction surgery. We went surgeon shopping, she selected the surgeon she felt most comfortable with and submitted for approval. She was denied. Because their in-house guy was demanding practically a double mastectomy.

I (ghost-)wrote an appeal letter, which included something like, "I have consulted with FIVE , in network, board certified plastic surgeons who came to essentially identical conclusions. But Aetna's in-house doctor has a different opinion. According to the California State Medical Board, the Aetna physician is a board certified ENT. If y'all really want to go to the Department of Insurance and defend THAT position...you bring your ENT and I'll bring my documents from five of YOUR in-network plastic surgeons... I'm ready."

We had an "Oh! There has been some misunderstanding" phone call in record time.

I would be tempted to ask them if they have documented their Internist's experience with both sleep apnea and bariatric surgery outcomes.

(I had severe sleep apnea pre-DS and "tested out" not too long after. My Bi-PAP is a major dust collector.)

 

[Amey]

Blue Cross doesn't even know the name of the internist.... He is a doctor that is part of an outside agency. He doesn't even sign his name to the letter. So if the letter isn't signed by any one person then how do I even fight that without a name to question their credentials? I asked for his name and they refused to give it to me saying it was 'confidential information'. I reminded him that it was my HIPAA right to know who has access to my file. And how the f can they even day a real doctor anything wrote the letter if nobody is willing to take responsibility for it??

 

[Amey]

Oh and that's why they sent it out to an Internist.... Because they don't have a 'like or same' doctor on staff. I have no idea how an Internist is like or same to a bariatric or pulmonary doctor. My brain hurts thinking about how they justify this bullshit.

 

[Spiky Bugger]

Oh and that's why they sent it out to an Internist.... Because they don't have a 'like or same' doctor on staff. I have no idea how an Internist is like or same to a bariatric or pulmonary doctor. My brain hurts thinking about how they justify this bullshit.

Their justification is that most people don't fight them...hang in there.

 

[Amey]

Thanks... That's just what I intend to do.

 

[DianaCox]

Listen to Attorney Bugger. I do.

 

[Amey]

Bugger rocks!! and so do you!!

 

[Spiky Bugger]

Listen to Attorney Bugger. I do.

Lol

 

[Spiky Bugger]

Blue Cross doesn't even know the name of the internist.... He is a doctor that is part of an outside agency. He doesn't even sign his name to the letter. So if the letter isn't signed by any one person then how do I even fight that without a name to question their credentials? I asked for his name and they refused to give it to me saying it was 'confidential information'. I reminded him that it was my HIPAA right to know who has access to my file. And how the f can they even day a real doctor anything wrote the letter if nobody is willing to take responsibility for it??

Hmmm...I'm wondering HOW OUTSIDE?...what do you want to bet their internist is a fully licensd physician...in Bangalore...or the vicinity...who is reviewing this stuff via the interwebz...like they do with our medical imaging? I'm calling bullshit on the "Anonymous Internist."

How does one file a complaint for a HIPAA violation? (And have you done it yet?). (Why not?)

 

[southernlady]

Oh and that's why they sent it out to an Internist.... Because they don't have a 'like or same' doctor on staff. I have no idea how an Internist is like or same to a bariatric or pulmonary doctor. My brain hurts thinking about how they justify this bullshit.

They CAN'T justify it. They will try but keep at them. What they want you to do is give up.

 

[robs477]

OM Goodness God!! You have been through SOOO much! I feel so sorry for you and my heart goes out to you. Kick those Wesley Bastards square in the NUTS! PLEASE don’t give up. We are ALL right here in your corner cheering you on, …and, you probably have THE BEST “advisers” on the planet helping you with Diana, Larra and that “Spiky B. Chicka” , and of course many others too. My best wishes for your success really do go out to ya.

 

[BebeZed]

I am so sorry you've had to march through hell for this! Keep fighting though - the insurance company puts up all these barriers in hopes you will just give up. I admire your persistence! We're all here rooting for you