Going Crazy

[shirleymahoney]

Would anyone like to come along......it's free

I was denied i am now in the process of an appeal with the insurance company i was told last November Doctor Gilligan was the only HCM Doctor in the state of Virginia and i told them that it is a referral from my Cardio doc and i was still denied, so their office is here in Virginia Beach and my husband is on his way down there, trying to explain to them that my Dr. doesn't want to sit on this being everyone that has gotten this disease has died in my family i'm the oldest living with it and i don't want the transplant if i can help it .that is why i'm being referred, so that Dr. Maron and Dr. Harris may have something else to try that may give me a better quality of life other than the transplant.


So cross your fingers for me or rather my husband

Shirley

[Lisa Salberg]

Re: Going Crazy

Good luck!

We are all thinking of you!

Take care,
Lisa

[Glen Beamish]

Re: Going Crazy

Sounds to me like the first action of the insurance companies is to deny and then hope you go away.
Good luck to your husband and you and hoping for a positive outcome..

[Pam Alexson]

Re: Going Crazy

We are all here wishing you and Ken success and a speedy process.
Pam

[Reenie]

Re: Going Crazy

Good luck. I know how frustrating this is.

Reenie

[Burton Borrok]

Re: Going Crazy

OK Shirley,
Pull out the policy from your insurance company. If I’m not mistaken on serious questions the insurance company MUST approve a second opinion. I even think it’s the law. On your computer go to the laws of the state, or ‘search’ for it – and check your state’s position on second opinions.

I am so fed up with the crap some of these insurance companies try to get away with. If you get the denial in writing, and your state’s insurance board or state law confirms your right to a second opinion, file a claim against the insurance company with the State Insurance Board.

That will not only get you the second opinion, it will get you identified as a squeaky wheel and in the future you will get the attention you deserve – promptly.

Let me know if you need any help with this.
Burt

[Debbie]

Re: Going Crazy

Shirley,

I know that in Colorado, at least, there is an "insurance comissioner" who moniters the activities of insurance companies.

My mother had a heart transplant, and then passed away. My father had some issues with the insurance companies paying some of the claims. He contacted the comissioner, and got immediate response. I'm sorry I don't know all the details, but can find them out if you would wish. (He is out of town right now, though, so I may not be able to immediately, but for future knowledge).

I would suggest that you do some searches under insurance comissioner for your state, and then contact them. I know that I have used this as a threat in some instances, and is it amazing how quickly the insurance company responds to that.

Just a thought, and good luck.

Debbie

[mtlieb]

Re: Going Crazy

It surprises me greatly that your insurance company wouldn't want you to get a second opinion from an expert. They're not going to want to pay for a transplant if they can help it, so it is in their best interest to allow you the referral, isn't it? Oh well... who knows how these people think! Good luck to you, Shirley and Ken... let's get this sorted out for you so you can be on your way to Minnesota!

Jim

[Laoshur]

Re: Going Crazy

Shirley,

If the trip by Ken doesn't work, which is a reasonably good bet, I have a suggestion that is similar to what others have suggested, but which is specific to the state of Virginia. There is a state insurance board that hears appeals about denied claims. To go to this board, you have to get a statement from the insurance company that they denied the claim. About three years ago a friend of mine with Type 1 diabetes needed an insulin pump. She and her doc tried and tried to get it, but the insurance co denied it every time. Finally, a friend of ours who worked in the claims office at doctor's office suggested she appeal to the state board. This is how the conversation with the insurance co on the phone went:

My friend: "I am calling to request a denial of claim form to appeal to the state board."
Rep: "I'm sorry, but you have to be denied a claim to get one of those."
Friend: "If you check your records, you will see that I have been denied on __, ___, and __ (etc) dates."
Rep: "Could you hold just a moment?"
New Rep: "Excuse me, but I am a supervisor. I believe that perhaps there has been some mistake made here. This claim should not have been denied. We will send the approval of this claim to the doctor immediately."

And they did.

At that same time I was having trouble with my company automatically denying all my claims. Whenever I called them with my proof that this was a legitimate claim, they always said that it was a mistake, so they would pay it. I got sick and tired of calling for every little (and big) thing. So, the next time I called, I said, "I know what your system is. You are instructed to deny every claim in hopes that people will just pay it themselves. Well, I am just warning you that I am keeping a record of every time I have to call and every time you decide after I present my proof that this is a legitimate claim. If the next claim I submit is rejected illegally, I want you to know that I will not call to request that you pay, but rather I will request a denial of service form and take this to the state insurance board to prove to them that you are denying service illegally."

Wow! You should have heard the explosion of denials from the other end. I just calmly said, "I can't prove what your company policy is, all I know is that I have phone records to prove that EVERY claim that I make is denied until I protest it. So, the next time this happens, I WILL contact the state insurance board.

Neither I, nor my husband, nor my daughter as long as she was on this policy, has ever had a single claim rejected since that time.

So, I conclude that in Virginia, the magic words are "State Insurance Board." Use them.

Meanwhile, I will pray that you have a good response even without this.

Rhoda

[Tigger1]

Re: Going Crazy

Good luck with the insurance company. Stay positive and things will work out for you...


Tigger1