Peer to Peer Update. DENIED 4th time (x post)

This must be one sick joke at this point.  So I got to work today and got a voice mail from someone in the Medical review dept telling me that the number I called isn't for me to call and its only for Dr to do peer to peer.  Now I called this number when my Dr told me no one called to have the peer to peer like they were suppose to at the set time given to them.  I found it ironic that someone gave me a call back for calling the number provided on the Denial letter but no one took the time to call my Dr back.  hmmm.  After speaking to my HR dept I spoke to someone who would refer my case to the Health care advocate.  When I got back from lunch today I got another voice mail from the Advocate that was assigned to my case.  I explain to her my entire situation and she sent me some forms to fill out releasing her permission to contact the insurance company and speak to someone.  She called me back an hour later and told me that someone call my Dr and left a personal number to call back and have the peer to peer.  She told me to still send her all my info just in case because she does not understand why they would deny me if I have all the qualification for the revision to DS.  Before I left work I sent her all the paper work and I sent Dr Roslin all of the info I sent to BCBS of IL showing proof I was compliant again just to have.  I wanted to make sure he had everything he needed to give them a good fight.  I left work and took my train ride home and when I got out of the train station I got and email from Dr Roslin telling me he spoke to the Dr and that we will have to do an outside appeal.  He said that the woman was very prejudice against obesity and that he wants to speak to the health care advocate himself.  At this point I have to do a full appeal. (SMH)  Im wondering when should I contact obesitylaw.com or the state dept of insurance.  Should I contact these people after I send an appeal and get a denial or should I be contacting them for help now?

Sorry to hear you're going through such hell with this... did they give you the reason for upholding the denial?

my opinion, you may be better off waiting for the appeal to go through before you get a lawyer or the ins dept involved... in reality, there's no grounds for any sort of legal action (yet) because you haven't exhausted the appeals process yet.

Best of luck to you.

Hi Sean

Thanks for responding.  I was thinking the same thing but wanted to be sure.  I didnt want to do anything without being sure at this point.  The insurance company is telling me the appeal is like my final straw so I want to make sure im doing everything right. 

 Contact Walter at ObesityLaw before you exhaust your appeals process.  Once you do external review they close the case, and I'm not sure how they handle it after that.  At least read the FAQ on the obesity law website and/or email them asking more information about it.  I hired them and it did not work out for me because I had an exclusion for the original surgeon I wanted to use (out of network), but I remember specifically understanding that you should get them involved the earlier the better.  Just my 2 cents.  

Sandy

Hi Sandy

I am two steps ahead of you.  I already contacted them and waiting for a response.

Oh my gosh I have a headache for you! :(  what a nightmare!!! 

All I can say is WOW.... I can not believe that they are putting you through all this....
In the end I guess it will make everything that much sweeter.... I am just so sorry for all this stress.... Dont give up.... We are here for you!