Peer-to-Peer Review = Denied Again

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NOOOOOOOOOOOOOO!!!!!    Oh Shelli, I'm so sorry.  We were all curious on Facebook and pulling for you. 

Okay, you get one day curled up in a ball so enjoy it.  Tomorrow, you mobilize and hit the ground running.  First of all, that scheduler is an ass and you should have told her so.  I will tell her so next time I see her. 

Next, this is just another speed bump - not a mountain.  Get your letters together and quote as many studies as possible to support your case.  Don't worry about Sheila writing the letter, I would suspect she does it all the time.  I would suspect she has a form-type letter that they use, just inserting personalized information when necessary.  If Dr. Sudan didn't like it, he wouldn't sign it, trust me. 

You'll get there, it will be reviewed and you'll get approved.  Does NC have any type of Ombudsman's office or something like that?  Maybe you can try that too? 

So sorry you hit this obstacle, but like a true champion, I know you will look at it and say "how do I get around it" and not let it throw you off your game.

I'm praying for you.    HUGS!

Here is NC external review information. Good luck! Oooh, I'm so mad they denied you. They suck....

External Review af Health Plan Denials

The North Carolina Department of Insurance Health Care Review Program (HCR) administers a free service called External Review, which provides another option for resolving certain coverage disputes between you and your insurance company. In North Carolina, external review is available when an insurance company denies coverage on the grounds that the requested service is not medically necessary (this is called a "non-certification" decision), or that the requested service is cosmetic or experimental for your specific medical condition.

For your request to be accepted for external review, you must meet the Program's eligibility requirements. A request is made directly to the HCR Program and each case is reviewed for completeness and eligibility. If accepted for external review, the case is assigned to an independent review organization (IRO) for a clinical review and final decision. Additional information about External Review can be found on the Department's Web site at www.ncdoi.com, or by calling the HCR Program at 1-877-885-0231.

Unfortunately, I had to delete this post due to privacy concerns.

Okay so let me just say that Christmas is 120 days from now.  Panic stricken?  I was!  According to this, the WORST case scenario is you have it right after the holidays.  You know that the time from Halloween to New Years flies by!  You will be switched just in time for a new year.  New year, new you! 

And that's the WORST case scenario!  

Maybe we'll end up being switch sisters!  I don't think he does too many a week but maybe I'll be entering the hospital as you exit!

Hang in there Chickie.  You'll win this battle. 

Unfortunately, I had to delete this post due to privacy concerns.

First of next year is what I'm hoping for myself!  If I get approved to have it then, I'm gonna be celebrating the heck outta Christmas!  Just think how great NYE will be, knowing that you are truly leaving behind that other life... I think it'll be fabulous!

Im so sorry Shelli:( I was really hoping that the peer to peer would go thru.

Well just keep truckin'!! You'll get the approval, i just know it!

dadgumitalltohell!!!!!    Hang in there!   Don't give up!!  Maybe we will end up surgery buddies!!

Unfortunately, I had to delete this post due to privacy concerns.