Advice on Appeal Process

Ok, I spoke to the HR person who handles our insurance, and I asked him for the information on the appeals process. He informed me that HE was the person to whom insurance appeals should be directed. He informed me that there is provision for only one appeal, which is reviewed by him (an employee of my company, in HR). He advised that I should be comprehensive in my appeal request and that I have 60 days in which to appeal. He also said that he then had 30 days to respond, but he thought he could handle the appeal much faster than that. He also stated that utilizing an attorney would be a "moot point" since the ruling on the appeal is final. It was almost as if he was hinting that he would overturn the denial... on just the brief data I gave him. Anyway, I'm debating using a ghost writer for the appeal, versus an attorney, versus just writing the letter on my own.... Opinions? Need to move on this quickly...

Kat, I would write a powerful letter of appeal and get the surgeons office to help you out. I personally feel it just depends on whos hands these things fall into. I really hope all goes well for you. I know you have been trying as long as I have if not longer. Good luck with your decision and give them all you got. JC

Kat, Is your insurance self funded? If that's the case then the HR person can overturn your denial. In a self funded case it is up to the employer unfortunatley. Like I told you the other day, you write well. I would write the letter myself if I were you because I KNOW YOU CAN and WILL write one heck of an appeal. Just stay focused and strong and you will get through this. I wish you all the best and if there is anything I can do to help you, please let me know. Good luck....now geaux get 'em tiger!!! Gina

Yep, they are a self funded hospital... and thanks for listening and for talking with me when I got the news. I am feeling much better and am ready to address the problem, just debating how best to do it. I think you're right... I can be somewhat pursuasive. I won't say WHICH religion I grew up in, since I no longer hold those beliefs... but I will say they made me dog-gone good at teaching others and pursuading others to see my point of view The only thing that scares me is that I have little to no documentation to back up my diet history, I did it almost all on my own, without docs. I can argue the point about "extreme risk" for someone of my BMI/waist size, but how can I argue with having no proof??